Medicaid

State of Play:  Following Congress’s failure to pass Affordable Care Act (ACA) “repeal and replace” legislation that would make significant changes to Medicaid, attention to this program has been focused on the states in 2018.  States are applying for section 1115 Medicaid demonstration waivers that would allow them to test new approaches to Medicaid.  These waivers address issues such as Medicaid expansion, eligibility and enrollment restrictions, requirements to seek work or participate in job training, benefit restrictions, copays, measures to incentivize healthy behaviors, behavioral health, delivery system reform, and long-term care services and supports.  As of last month, the Centers for Medicare and Medicaid Services (CMS) has approved 45 of these waivers across 37 states. 27 applications are pending across 28 states and 1 has been invalidated by the courts (KY). Most approved and pending waivers center around behavioral health.

HLC Position:  Medicaid serves as an important and viable safety net for low-income individuals and families who do not have access to either employer-sponsored insurance or the individual insurance market.  There are ways to increase efficiency in the program, but such policy changes should maintain access to the healthcare safety net for our country’s most vulnerable citizens.  Drawing from private-sector progress in moving to pay for value, the Medicaid program should encourage the use of waivers for state Medicaid programs that emphasize value-based care and care coordination as well as increased patient engagement and adherence.  HLC also supports streamlining the Medicaid application process and incentivizing healthy behaviors and care management for Medicaid enrollees.  Additionally, the Children’s Health Insurance Program (CHIP) should continue to be funded so that children have access to care.   

HLC Recent Activity: 

  • In November, HLC finalized the high-need beneficiary playbook with recommendations on improving care for high-need, high-cost patients and has begun distribution to congressional offices and other health policy thought leaders and staff. The playbook addresses recommendations to state Medicaid agencies.
  • On August 3, HLC wrote to the Healthcare Innovation Caucus on pursuing innovation in healthcare to provide higher quality care, lower costs and improve health outcomes.
  • In its July 13 response to HHS’s request for information regarding drug pricing, HLC explained disincentives to manufacturers’ participation in Medicaid value-based arrangements arising from the Medicaid Best Price rule.
  • On June 20, HLC’s National Dialogue for Healthcare Innovation (NDHI) released a roadmap of recommendations as follow-up to the Opioid Crisis Solutions Summit where “gold star” recommendations were discussed on opioid care management, including the management of Medicaid beneficiaries. HLC also developed a compendium of its members’ best practices on opioids.
  • Following a presentation by Melanie Bella, the former director of the Medicare-Medicaid Coordination Office at CMS, at HLC’s January Access and Coverage Task Force meeting, HLC worked with its members to develop a playbook on improving care for high-need and high-cost patients. This playbook includes suggestions for Medicaid beneficiaries.
  • HLC updated its “red tape” list of suggested regulatory reforms, including modernizing Medicaid best-price reporting regulations to support value-based arrangements. HLC shared this list with HHS, as well as the House Ways and Means Committee, the Senate Health, Education, Labor, and Pensions (HELP) Committee, and members of Congress.
  • HLC is working with the Modern Medicaid Alliance to educate the public and policymakers about Medicaid.