WA--Nagele, Cori

I write to submit comments on the new rule and unified agenda item: Medicaid Eligibility Changes Under the Affordable Care Act, Part II (CMS-2334-P). My union, AFSCME Council 28, represents thousands of Medicaid eligibility determination workers for the state of Washington. I write in strong support of the decision to revert to the policy “that state Medicaid agencies would be limited to delegating eligibility determinations to Exchanges that are government agencies maintaining personnel standards on a merit basis,” as expressed in the rule’s preamble. To achieve this change, we support the proposed deletion of 42 CFR 431.10 (c) (3), which would have allowed non-governmental entities to contract for eligibility services. Further, we support the proposed addition of language at 431.10 (c) (2) to require that any entity to which eligibility authority is delegated be a governmental agency that maintains personnel standards on a merit basis. While the new rule acknowledges the multiple ways that individuals may begin the process of gaining health coverage in post-ACA America, it reaffirms that final eligibility determination for Medicaid can only be conducted by a publicly operated entity. This construct has been a consistent legal interpretation for eight successive administrations. To unravel this important foundation would jeopardize benefits for vulnerable individuals and families; and would decimate good, middle-class jobs that our nation needs in order to remain strong. Our members appreciate the Obama Administration’s efforts to accommodate state flexibility in implementation decisions around the Affordable Care Act, while reinforcing the basic tenet that Medicaid eligibility determination is an inherently governmental function.