Response to 60-day Comments

APPENDIX A – CMS RESPONSES TO PUBLIC COMMENTS RECEIVED FOR CMS10383

The Centers for Medicare and Medicaid Services (CMS) received six comments, all from individual
members of the public (three were anonymous), all of which were generally out of scope relative to
CMS-10383. Since the comments were brief, they have all been quoted below along with CMS’
response.
Comments:
1. “Navigation the system is no easy task. Perhaps a quarterly upgrade to study effective
changes.”
2. “This rule change will cost money with no benefit. It will hurt the most vulnerable of our
population for no reason. There is no data to support this measure.”
3. “I strongly oppose this proposal. Research clearly shows that a large majority of Medicaid
adults are already employed in full-time jobs that are physically demanding! Medicaid
clearly improves health outcomes and Medicaid adults must be healthy enough in order to
work. Yet, Medicaid adults face the highest rates of food insecurity and financial hardship
since they are already living at or below the poverty line. Finally, many Medicaid adults do
not use computers, the internet or email, which could be a barrier in finding a job and in
complying with work reporting requirements. The Centers for Medicare and Medicaid
Services, under the Department of Health and Human Services, is a publicly funded agency.
I am a stakeholder in this proposed rule and I demand that CMS withdraw it immediately.
4. “Good”
5. “Good”
6. “I wish to comment on the CMS Agency Collection Activities; Proposals, Submissions, and
Approvals. I have serious concerns about states utilizing 1332 Waivers to impose or tighten
eligibility or work requirements on persons with disabilities. I have concerns about those
with disabilities and chronic illnesses who may experience disabilities who need grace
periods or experience gaps in their work life due to medical issues. I am proud to work and
serve the northcentral Montanans I do serve through my work. In our policies and laws, as a
nation, we need to build a workforce of citizens with disabilities whose skills can thrive. No
one should be forced to choose between healthcare and working. I believe that we need a
benefits planning system that is coordination with the Social Security Administration, the
Department of Labor where Vocational Rehabilitation is housed and Department of
Education where Special Education or accommodated education is housed to ensure that
working is a part of life rather than a way to maintain or obtain needed benefits.
In the meantime, I hope that you will explore opportunities to allow states to increase
opportunities for flexibility in service packages. CMS needs to strongly consider making
Home and Community Services and Community First Choice mandatory Medicaid Services
on par with nursing home services. CMS also needs to coordinate between Medicare and
Medicaid to allow Seniors to pay for home health or personal assistance and or home
modifications. We need to explore many options to enhance services. Thank you for allowing
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me to comment on these important issues.”
Response:
CMS appreciates the interest in CMS-10383, concerning waivers under section 1332 of the Patient
Protection and Affordable Care Act (PPACA). Overall, the comments received do not pertain to the
1332 waiver program or to solicit any actionable response from CMS in terms of implementing this
program.
To address two specific points, comment three and six express concern about the Medicaid
program; however, 1332 waivers do not pertain directly to the Medicaid program. The concern here
is with section 1115 Medicaid waivers, which are not within the scope of CMS-10383.
Comment six also expresses concern that 1332 waivers restrict eligibility requirements; however,
section 1332 requires that as many consumers must have access to coverage as would have access
under PPACA. Moreover, under section 1332, states can further tailor eligibility requirements for
specific products to suit state-specific needs.

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