Medicaid Work Requirements Could Negatively Impact Cancer Care Access, Increase Cost Burden on Patients

Welcome to this "ASCO in Action" podcast. This is ASCO's monthly podcast series where we explore policy and practice issues that can impact oncologists, the entire cancer care delivery team, and most importantly, of course, the patients we care for, people who have cancer. My name is Clifford Hudis, and I'm the CEO of ASCO as well as the host of this "ASCO in Action" podcast series. And for today's podcast, I am really delighted to have with me Dr. Manali Patel, chair elect of ASCO's health equity committee. Dr. Patel is here as our guest today to talk about some interesting issues for that committee and for all of us in ASCO. Our conversation today is going to focus on ASCO's recent position statement on Medicaid waivers. For those of you who aren't following this or have been tuned out for a little while, there are several states that have recently submitted waivers to the Centers for Medicare and Medicaid Services-- what we generally call CMS-- asking for the agency to approve changes to the Medicaid program in their state individually that would make eligibility, continued coverage for care, cost sharing, and other program benefits dependent on the beneficiary's work status. Some state waivers have also requested the authority to cut coverage for beneficiaries based on them not paying premiums, on eligibility re-determinations, and on other work requirements. Simply put, these are challenges because they could restrict some access to care, and they put ability to work into the mix for oncologists to consider. So here at ASCO, we're concerned. We're concerned especially that Medicaid work requirements may hinder patient access to essential cancer care services. They may reduce the already limited time that physicians have available to spend with their patients, because they will require, in some cases, doctors to do work related to assessing employability. And our position statement, therefore, recommends that federal and state policymakers take very specific steps to ensure that new Medicaid requirements do not harm patients with cancer. So to dig deeply into this, Dr. Patel has joined us. And I welcome you, Dr. Patel. And thank you for coming on this discussion today. Well, it's an honor and a privilege to be here today. Thank you. So I want to start with a little more background on the type of waivers that we're talking about here. And there's always a nomenclature that's confusing to the outside world. These are called 1115, 1-1-1-5 waivers. What is their intended purpose in the Medicaid program? Section 1115 of the Social Security Act gives the secretary of health and human services essentially the authority to waive particular provisions of the Medicaid program in hopes to further the Medicaid program's objective. 1115 waivers provide states an avenue to test new approaches in Medicaid that can potentially improve their programs but that may differ from what the federal program rules currently are. These 1115 waivers are subject to public comment. They must be budget neutral for the federal government. And while there is great diversity in how states have used these waivers over time, generally these waivers reflect the priorities that are identified by the states and the current administration. And just out of curiosity, who submits the terms or the concepts that are being considered in these waivers? Do they bubble up from the state? They come down from the federal government? Do they come from some other source? What's interesting about these waivers is that they do come from the states themselves. However, there is great encouragement by the administration in terms of what waivers they would encourage states to apply for and which waivers they would approve. The secretary of the health and human services is the one that makes the authority for approving the waivers themselves. But the states themselves are the ones that submit the waiver provisions in hopes that it will align with what the administration's