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Public Shut Out of Public Policy
DSHS Seeks to Radically Alter Medicaid
by Phil Jordan
December 18, 2001
Medicaid costs are rising in Washington state and the Department of Social and Health Services (DSHS) is trying to do something about it. They are seeking the authority to slash some services, and force recipients to pay premiums and co-payments for others. In addition, the state wants to have the power to impose waiting lists on new applicants for certain programs.
Currently, Medicaid coverage is an "entitlement," meaning that those who qualify for coverage due to disability or lack of income must be provided services. Medicaid was created to provide medical coverage for those who are unable to pay for health care.
DSHS is seeking the authority to change Medicaid from an entitlement program to one where the state could "cap" enrollment (prevent new applicants from receiving benefits). Furthermore, the state would ask recipients to shoulder some of the costs of ever-increasing medical expenses.
State Seeks Medicaid Waiver
The power to impose waiting lists and cost-sharing on some of the poorest people in the state would be obtained by asking the federal government for a "waiver" to current Medicaid rules. DSHS claims that it needs the flexibility to alter the conditions of Medicaid eligibility because of skyrocketing medical costs. However, the state’s own data indicates that one of the biggest reasons for the increase in medical costs is prescription drug price increases. The proposed waiver would have no effect on drug prices.
Interestingly, DSHS provided no figures indicating how much money the state would save if the proposed waiver is approved by the federal government. Advocates believe the state would not realize any cost savings from the waiver. In fact, people who would lose Medicaid benefits would have no choice but to delay or forgo needed health care until they reached a crisis. The cost of crisis care is usually significantly higher than what it would have cost had the patient received care earlier.
Proposal circumvents public input & process
The most disturbing aspect of the DSHS pursuit of this waiver is that they have consistently tried to avoid allowing the public to have any meaningful input into the process.
The opportunity for public involvement in this waiver proposal has been inadequate for several reasons.
1. Public Comment period was misrepresented
DSHS did not give the public an adequate opportunity to comment on the proposed waiver. DSHS arranged meetings called "Community Conversations" that were meant to provide the public, especially those who receive the services that would be directly influenced by the waiver, the chance to comment. However, these meetings were scheduled and advertised before the state announced that they were seeking the waiver! Furthermore, the flyer announcing the Community Conversations makes no mention of the proposed waiver, and implies that DSHS would be informing the public of its intentions, NOT inviting the public to comment on an important change in state Medicaid policy.
2. DSHS failed to provide the specifics of the proposal prior to the public’s opportunity to comment
The public had no opportunity to see the text of the proposal prior to the Community Conversations that ostensibly afforded them an opportunity to comment. All of the public meetings publicized by DSHS in their Community Conversations flyer took place prior to the release of the draft waiver proposal. The Department did add several Community Conversations subsequent to the release of the flyer, but it is questionable at best that these meetings were adequately publicized. Furthermore, only one of those meetings occurred after the release of the proposal, and that took place the day following release of the draft waiver proposal.
3. DSHS designed the waiver proposal to circumvent any meaningful public process
If this waiver proposal is approved by the federal government, it would allow the state Legislature to make alterations in Medicaid services at unspecified times in the future without providing opportunity for public comment on those changes.
If the waiver is approved, the State would gain the ability to make specific changes to the state Medicaid Plan without any public input. The Department is currently responding to criticisms of potential impacts of this waiver by declaring that they are not actually proposing specific changes in Medicaid services in this proposal – they only hope to gain flexibility. It is the Legislature, the Department contends, that will make decisions on changes to Medicaid. However, those changes could be accomplished behind closed doors with no public involvement.
Public Policy created in secret
The State should not seek a waiver that effectively takes citizens "out of the loop" of public policy discussions, especially when the individuals who are most affected by policy changes will be shut out of those discussions.
Want to know more about the state’s proposed waiver? Check out these links:
 | Text of the waiver proposal (scroll down and click on "Final Waiver Proposal") |
| Waiver Fact Sheet (written by Julie Chinitz of the Northwest Health Law Advocates, or NoHLA) |
| Unanswered Questions Raised by the Waiver (by NoHLA) |
| WPAS Comments submitted to DSHS and CMS |
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