February 27, 2006

The Honorable Charles E. Grassley
Chair, Committee on Finance
135 Hart Senate Office Building
Washington, DC 20510-1501

The Honorable Max Baucus
Ranking Member, Committee on Finance
511 Hart Senate Office Bldg.
Washington, D.C. 20510-1501

Dear Senators Grassley and Baucus:

As you know, the Medicaid program provides vital health and long term care services to millions of children, families, pregnant women, seniors and persons with disabilities. Medicaid has significantly reduced the number of people without health insurance, substantially facilitated access to medical care and long-term services and supports, and improved health for large numbers of low-income people. As organizations that represent beneficiaries, providers, and other key stakeholders, we write to express our concern that significant and complex policy changes are being made to the Medicaid program through the Section 1115 waiver process with little opportunity for legislative oversight and public input.

In return for its substantial financial commitment, the federal government has established national coverage standards, and given states additional options to tailor coverage to the needs of their residents. Section 1115 waivers have long been a tool to give states additional flexibility. Recently, however, the Centers for Medicare and Medicaid Services has approved far-reaching waivers that depart from critical federal coverage standards, with minimal opportunity for public input. In October, for example, CMS approved a ground-breaking waiver for the state of Florida’s Medicaid program in just sixteen days. Subsequently, the states of Kentucky and South Carolina have submitted major waiver proposals, and we are concerned that they may be moving on a fast track as well.

These waivers establish national precedents which depart from the federal standards Congress established for the Medicaid program. As such, we would like to work with you over the coming months to ensure that these major changes in the way Medicaid serves low-income people are subject to appropriate public input and Congressional oversight, and that the ramifications of these changes for beneficiaries and the people and providers who serve them are well understood.

We very much appreciate your leadership on this important issue and look forward to working with you.

AIDS Action Council
The AIDS Institute
African American Health Alliance
Alzheimer's Association
American Academy of Pediatrics
American Association of People with Disabilities
American Diabetes Association
American Federation of State, County, and Municipal Employees
AFL-CIO
American Medical Student Association
American Occupational Therapy Association
American Public Health Association
ANCOR
Association of University Centers on Disabilities
The Arc of the United States
Bazelon Center for Mental Health Law
Center for Adolescent Health and the Law
Center on Budget and Policy Priorities
Child Neurology Society
Children's Defense Fund
Children's Dental Health Project
Child Welfare League of America
Consumers Union
Easter Seals
Epilepsy Foundation
Families USA
HIV Medicine Association
Housing Works
March of Dimes
National Association of Councils on Developmental Disabilities
National Association for Children's Behavioral Health
National Association of Social Workers
The National Citizens' Coalition for Nursing Home Reform
The National Committee to Preserve Social Security and Medicare
National Council on Independent Living
National Council of Jewish Women
National Council of La Raza
National Disability Rights Network
National Family Planning and Reproductive Health Association
National Health Council
National Health Law Program, Inc.
National Mental Health Association
National Respite Coalition
National Senior Citizens Law Center
National Spinal Cord Injury Association
National Women's Health Network
National Women's Law Center
NETWORK – A National Catholic Social Justice Lobby
Physicians for Social Responsibility
Racial and Ethnic Health Disparities Coalition
RESULTS
Service Employees International Union
Summit Health Institute for Research and Education, Inc.
United Cerebral Palsy
United Spinal Association
US Psychiatric Rehabilitation Association
Voices for America’s Children
Welfare Law Center