This includes the mandate that majority people are insured or pay a penalty. The state will need to have a plan that will cover a maximum of people - as many as the federal government. People will not have to pay more for fewer benefits - to avail the waiver.
Vermont proposed a single-payer system in which all residents enrolled in a state-run health-insurance program. The first of its kind in the U.S., the program would offer supplemental coverage for people who already have insurance through a job or Medicare, and cover everyone else who would otherwise be in Medicaid, the individual insurance market or uninsured.
In addition to the federal waiver, the state needs to reach agreement on how to pay for it.
Maryland, is unique in that it sets hospital prices rather than having them negotiated through individual insurers or set by Medicare. This move is approved by the Centers for Medicaid and Medicare services. Hospitals would be paid a fixed annual sum for a certain population rather than for services rendered.
Scott Walker, Gov. of Wisconsin re-shaped the state's Medicaid program- this state already provides Medicaid facilities to a wider income range allowing even those above poverty levels to enroll. Now some of these people qualify for tax credits when they buy health insurance under the Affordable Care Act. Gov. Walker has removed these people from Medicaid as they gain on tax credits and is now enrolling more of the state's lowest income residents under Medicaid.
Several other Republican governors also have grappled with the ACA's implementation, particularly the Medicaid-expansion provision.
For some states, particularly those with historically stringent requirements for Medicaid eligibility, the expansion was seen as more than they could afford, so they opted out.
The proposals have put federal officials in a tricky position, as they want states to enroll more people under Medicaid and give access to millions of Americans to health covers, while preserving what Medicaid advocates say are key tenets of the program, including its guarantee of assistance to vulnerable Americans.
Hannah Punitha (IRDA Licence Number: 2710062)
Louise Radnofsky, June 2014