New CMS Block Grant Guidance Encourages States to Pursue Policies that are Harmful to People with and at Risk for Lung Disease

Yesterday, the Centers for Medicare and Medicaid Services (CMS) issued new guidance for state Medicaid programs on applying for block grants through Section 1115 demonstration waivers. Below is the statement of the American Lung Association in response to this announcement:

“The American Lung Association is deeply concerned about today’s announcement from CMS inviting states to block grant their Medicaid programs. Block grants would cause significant harm to the health and well-being of patients with lung diseases and other pre-existing conditions. Congress, which has authority over the funding structure of Medicaid, has repeatedly declined to pass legislation authorizing block grants, most recently during the debate over repealing and replacing the Affordable Care Act in 2017.

“Today’s guidance encourages states to pursue policies that would jeopardize patients’ access to care. States could adopt closed formularies that restrict prescription drug coverage, which would limit access to evidence-based care for patients with lung disease, including access to life-extending and life-saving new therapies for patients with lung cancer. States could continue to pursue work reporting requirements, even though a federal district court has vacated three waivers with these policies because of the threat they pose to coverage in the Medicaid program.

“The guidance also allows states to: 

• Increase patient cost-sharing;
• Eliminate important wraparound benefits, including providing transportation to help patients get to medical appointments;
• Reduce oversight of managed care programs, including by changing network adequacy protections for patients;
• Eliminate retroactive coverage and,
• Make future changes to their programs without federal approval and input from stakeholders, including the patient community.

“All of these policies put patients’ care at grave risk.

“The American Lung Association will continue to protect patients with lung disease by opposing block grant proposals that states put forward under today’s guidance and instead champion full Medicaid expansion in all fifty states.”