Medicaid Work Requirement Guidelines Issued

Yesterday, CMS announced "new policy guidance for states to test community engagement for able-bodied adults," otherwise known in common vernancular as work requirements. CMS is framing this announcement as a way to support state efforts to improve Medicaid recipient health outcomes by incentivizing work for "able-bodied, working-age Medicaid beneficiaries." The policy is in response to 10 states that have requested a "115 Medicaid Waiver" demonstration program under which work or "participation in other community engagement activities"- which include things like skills training, education, job search, volunteering or caregiving - qualify as a condition for Medicaid eligibility. Excluded from the program are the disabled, elderly, children, and pregnant women, who make up the majority of Medicaid recipients. The 10-page letter issued yesterday, argues that working promotes good health and repeatedly asserts that the change fits within the program's objectives. 

Critics argue that able bodied individuals who are collecting Medicaid and are not sick or caring for family members - or students, are a relatively small portion of the overall Medicaid population, which now covers one in every five Americans and is the nation's largest insurance program. Also, many Medicaid recipients already work full time, but have wages so low that they still qualify for Medicaid. Recent analysis by the Kaiser Family Foundation, and JAMA put the true number of able bodied, non elderly, unemployed (i.e. not a caregiver, student, or volunteer), and not retired, at somewhere between 13%-25% of the Medicaid ranks, and most of those are older workers (51-64). They also argue that the cost of implementing and administering such a program may not result in much cost saving.

In Maryland, of the more than 1.2 million Medicaid recipients in the state, 390,000 are classified as non disabled, or non elderly. 74% of them are working or have a family member already working. 

Of the 10 states that have applied for the waiver program, Kentucky may be the first state to enact the new requirements - perhaps as early as today. 


Maryland Health Connection released the numbers for the 2018 Open Enrollment season today. For a full version of their press release click here.  In the meantime, here are some highlights:

  • A total of 153,571 Marylanders enrolled in private health coverage during the 2018 open enrollment for Maryland Health Connection, compared to 157,637 who enrolled in 2017 - an enrollment period that was twice as long - 90 days compared to this year's period of just 45 days.

  • Consumers aged 18-34 made up 30% of total enrollments, the same as a year ago when Maryland ranked 5th in the nation for its percentage of young-adult enrollments.
  • African-American enrollment was up 12% and Hispanic enrollment increased by 10% over 2017.

  • Enrollment also rose in rural areas, including an 11% increase in the Far Western region of Washington, Allegany and Garrett counties and a 9%  jump in the Lower Eastern Shore region of Somerset, Wicomico and Worcester counties. “We were particularly pleased to make greater inroads covering Marylanders in rural areas,” Eberle said. Maryland ranked fourth in the nation in gains in rural health coverage between 2013 and 2015, according to a Kaiser Family Foundation analysis last year.
  • Consumer assistance organizations that provide free enrollment help to Marylanders, also saw a 46% increase over a year ago despite the shorter period this year, assisting more than 37,000 enrollees.
  • There was a significant shift in carrier choice, largely driven by rate increases, and other carriers leaving the marketplace. CareFirst BlueCross Blue Shield now has 55% of the market, down 9% from the previous two years and down 39% from the first year of Maryland Health Connection in 2014 when they had 94% of the market. Kaiser Permanente continued to show increasing growth with 45% of the market share, up 9% from 2017, and way up from only having 4% of the market share in 2014. 

2017: A Year of Challenges and Opportunities

The challenges of 2017 hardly need a recounting, but they included three bills designed to "repeal," not replace, the Patient Protection and Affordable Care Act (ACA). All were defeated thanks in no small part to the strength of advocates across the nation. Then, there is the continued absence of funding for CHIP and community health centers, and efforts to limit eligibility in Medicaid while proposing block grants or per capita caps that would devastate this vital safety net program. Further challenges are reflected in regulations designed to weaken outreach and enrollment efforts. And, just this week we learned that there is an effort to ban the use of certain words in government budget request documents that include fetus, diversity, vulnerable and evidence-based.

As we move into 2018, we have no illusions that such efforts will continue to negatively impact the health of individuals and our communities. Therefore, we are thankful that the majority of Maryland's leaders have stood strong against this onslaught and we know they will do so in the future. We are also grateful for our many partners, who have worked diligently to seize all opportunities to mitigate any harm from Federal actions while continuing to advance health reform in Maryland. 

As a result, we did make some progress this year. Here, you can find a list of our policy and advocacy agenda since passage of the ACA, and under the umbrella of our Health Care. Keep It! campaign, we had a number of major achievements this year. They include:

  • Maryland Medicaid Collaborative - Consumer Health First brought together twenty organizations, representing the 1 in 5 Marylanders covered by the Medicaid, to address and/or mitigate any proposed alterations to the program at either the state or federal level. This Collaborative builds upon CHF's work to get included in the Budget Reconciliation and Financing Act language that will require the Maryland Departments of Health and Human Services to collaborate with stakeholders on "changes to, or redesign of" the Medicaid program;
  • Network Adequacy Regulations - Following passage of our bill to require quantitative and qualitative standards in 2016, we saw regulations promulgated that are among the most stringent in the country. These include both wait time and distance standards, as well as greater transparency of carriers' access plans and compliance with those standards. A big win for Marylander!
  • Active Advocacy on all levels - Consumer Health First has: 
  1. Participated in multiple committees, including: HSCRC Consumer-Standing Advisory Committee and Performance Measures Workgroup; MHBE Standing Advisory and Plan Management Stakeholder Committees and the Standardized Benefit Plan Workgroup; and the SB340 Health in All Policies Workgroup;
  2. Participated in multiple events across the state; 
  3. Gained media coverage - both state and national; and 
  4. Submitted endless comments on everything from the new HHS Strategic Plan to Maryland's Plan Certification Standards. 

In some areas, such as the effort to keep insurance rates down, we have been less successful, but that isn't for lack of trying! Our work on Maryland's rate review process will continue in 2018 as will all of our other efforts to ensure that Maryland is a state that fully recognizes and acts upon the goal of health equity with access for all.  

Next year, we will continue to be the voice for Maryland's health care consumers (that's all of us) and we will be launching an exciting new education campaign. Stay tuned!

Today, though, we need your help. We recognize that there continue to be many challenges ahead, but there are also opportunities that Consumer Health First is uniquely qualified to address. Please make a year-end donation. Just as we ask Marylanders to become more engaged in their health care, we ask you to engage with Consumer Health First.

Learn more about how we will put your donation (small or large - all are equally important) to work and donate today. It's easy and all donations are tax deductible:

  • Send a check made payable to Consumer Health First, P. O. Box 59202, Potomac, MD 20854
  • Or just press the Donate button in the menu bar above.


Marylanders are getting an early Holiday gift!! The new Executive Director of the Maryland Health Exchange, Michelle Eberle, announced today that Open Enrollment for 2018 will be extended until Friday, December 22nd to allow people more time to shop and sign up for benefits.

In an article in the Baltimore Sun, she stated:

"There is a strong indication that we are going to have a lot of folks coming back for renewal and a lot of new folks who heard about what’s going on,” said Michele Eberle, the incoming executive director of the Maryland Health Benefit Exchange. “Once again we’re hearing from consumers how important having health coverage is to them. … They’re grateful to have insurance.”

MHBE reports that enrollment is up about 12% above this same period last year, and on the Eastern Shore, numbers are reported to be up by as much as 40%.  But due to the truncated enrollment period and last minute premium increases caused by actions of the Trump administration, MHBE administrators felt this extension would allow people to shop around and consider a more comprehensive gold plan, that could be a better value by reducing deductibles in exchange for slightly higher premiums. Those buying more moderate silver plans should consider buying directly from an insurer, as some premium increases approved by regulators only affect the silver plans bought through the exchange.

Last year, 9 out of 10 Marylanders received financial assistance in purchasing a health plan on the exchange. This year, many people who receive a tax credit may find that their premiums are available at much lower rates than last year, if not for free.

Navigators are standing by, and bi-lingual assistance is available. Enroll today!

With Enrollment Ending this Friday, Former President Obama and Former CMS Chief Andy Slavitt Team Up to Get the Word Out

The Young Invincibles hosted a webinar on Monday, December 11, titled “Open Enrollment Final Push Conference” featuring special guest speakers (former) President Barack Obama and (former) Acting Administrator of CMS, Andy Slavitt. President Obama thanked everyone who does the “on-the-ground “ work for their efforts and their commitment to getting individuals health care coverage despite partisan politics.  He also noted that the goal was, and is still, to have “a health care system that works for everyone”. 

Former First Lady Michelle Obama chimed in too!

Former CMS Commissioner, Andy Slavitt, also thanked everyone and said that “everything you have done makes a difference”.  Both speakers encouraged people to remind everyone of the December 15th deadline coming up this Friday, and they encourage people to tell everyone to use social media (Facebook, Twitter, and Instagram) to tell their friends noting that “everyone is at risk if they don't sign up by December 15th."

Visit today. It’s the only place you can get financial help with your health plan. In fact, 9 out of 10 people who got covered through Maryland Health Connection got financial help that lowered the cost of their plan.

Exciting News at Consumer Health First!

Kathy Ruben, M.S., Ph.D.

Kathy Ruben, M.S., Ph.D.

For over a decade Consumer Health First has built the reputation of putting the interests and needs of consumers first as Maryland has designed and implemented our health care reform initiatives. During that time, colleagues have described us as reliable, professional, honest, and fun. Today we are excited to announce a strong new team to address the future. (Read our press release) These appointments underscore the Board's commitment to our mission and to both the stability and sustainability of Consumer Health First.

  • Dr. Kathleen Ruben has taken up the position of Executive Director - effective December 4. Kathy has a Doctorate in Health Services Administration from the University of Maryland School of Public Health and she comes to us with a wealth and depth of experience that will serve to reinforce and expand the value of our work. Most recently she served at the Maryland Health Care Commission, first as an Advanced Health Policy Analyst and more recently as a Program Manager. In that position she worked on the just-released MHCC Report - Transforming Maryland's rural healthcare system: A regional approach to rural healthcare delivery - and on regulations for behavioral health facilities and services in Maryland. 
  • Beth Sammis, who has been serving as CHF Secretary, will become President of the CHF Board on January 1, 2018. She began her career in Maryland at the Department of Legislative Services and more recently served as Acting Insurance Commissioner. She brings not only a depth of expertise to CHF but also a strong sense of humor that will stand us all in good stead as we face both the challenges and opportunities ahead. Beth will be joined by Leni Preston as Vice-President; Mary Lou Fox as Treasurer; and Madeleine Shea as Secretary. With the other members of the Board, CHF continues to have a strong bench to lead the organization into its 13th year of operation.  

For much of Consumer Health First's history, I have been privileged to serve as both President and CEO. Our success has rested upon an outstanding team drawn from among Maryland's leading policy and advocacy experts. Some serve on the CHF Board. For those who may be interested in joining our Board please contact me. Our team also includes our national and state partners, Maryland's elected officials and decision makers, as well as a diversity of other stakeholders.

We are very excited to have Kathy at the head of CHF and we all look forward to joining forces with our many partners to forge a state where health equity is advanced through access to high-quality, comprehensive and affordable health care. 

Leni's Signature 200.png

Leni Preston, President; Cell: 301.351.9381