CMS BLOG
https://blog.cms.gov/2016/04/25/medicaid-moving-forward/
April 25, 2016
By Andy Slavitt, CMS Acting Administrator and Vikki Wachino, CMS Deputy Administrator and Director for the Center for Medicaid and CHIP Services
Medicaid
Moving Forward
If you haven't been
paying close attention over the last several years, you may have missed
some of the major changes that have taken place in the Medicaid program.
You may know that some 72
million Americans rely on Medicaid as their source of health insurance coverage
this year – 14 million more than in October 2013 thanks largely to the
Affordable Care Act’s coverage expansion. For millions of children who need
checkups or follow up care, pregnant women who want their babies to get a
healthy start in life, adults who need health coverage when they unexpectedly
lose a job, or people with disabilities who want to live independently in their
communities, Medicaid has been there over the last 50 years to provide
comprehensive health coverage to millions low-income American families.
But a lot has happened to
health insurance coverage through Medicaid over the past several years as
millions more people have gained coverage because of the Affordable Care Act:
The federal government and the states have sought to strengthen the program’s
focus on the consumer, the delivery of high quality care, and providing greater
access points, and on developing a modern set of rules.
Today, we’re taking a next step in
that work today by finalizing a long-anticipated rule
that updates how Medicaid works for the nearly two-thirds of beneficiaries who
get coverage through private managed care plans. These improvements modernize
the way these managed care health plans operate so
that Medicaid and CHIP continue to provide cost-effective, high quality
care to consumers. The rule strengthens states’ efforts to support
delivery system reform and authorizes the first-ever Medicaid and CHIP quality
rating system so that states can publicly report plan quality information,
and people can use that information to select plans. It
also deploys 21st century tools to improve beneficiary
communications, like electronic notices to beneficiaries and creating
online provider directories. It better aligns key rules and
practices with those of Marketplace and Medicare Advantage,
including the addition of reporting medical loss ratio to Medicaid to ensure
managed care plans focus on delivering care, not profits. And the rule
also helps strengthen and improve the delivery of health care to low-income
children served by the Children’s Health Insurance Program (CHIP).
But before you look at a summary of
these rules, it's worth catching you up on other major developments in Medicaid
that affect every aspect of the consumer's experience--from enrolling, to
accessing high quality care, to the availability of home and community-based
services.
- A modern enrollment
experience.
Applying and enrolling in Medicaid coverage is now easier than
it once was and similar to the processes for applying for other
health insurance programs. Enrolling into
Medicaid was once very complicated, involving lots of
paperwork, long waits and in-person interviews. Now, most people
apply on line, by phone, or at a location convenient for them. More
convenient, one-stop enrollment is possible in part thanks to
sophisticated technology pursuant to the Affordable Care Act that
allows enrollee information to be verified
electronically – and without paper documentation. In some
states, as many as 50 percent of individuals now enroll through these
automated processes.
- Access to high quality
physicians and other care providers. Access to quality health servicesis always a central
focus of CMS, which was strengthened
through new policies recently that seek to ensure access to care.
Today's rules take additional steps that will more tightly align payment
with better, more cost-effective care. And new rules create real
accountability to ensure access to care is sufficient in key
specialties.Thanks in part to the work that CMS and states have
done to make sure people have access to health services,
adults with Medicaid coverage are just as likely to obtain primary care
services as those with private insurance, while experiencing
less
difficulty paying their medical bills than others. And,
people with Medicaid coverage report
very high satisfaction, even higher than those who get health
insurance through their place of employment.
- Quality care to
strengthen health outcomes. Medicaid is also transforming the delivery of
care. States
are making gains in using population based payments, episodes of care,
and quality-based payments. In addition, states operate 30 health home
programs that focus on coordinating care for people with chronic
conditions like obesity, diabetes and mental health conditions. Over the
last several years, sates have undertaken significant efforts through
State Innovation Models, integrated care models, and delivery system
reform incentive programs to create alignment with physicians and
hospitals to provide the highest quality of care. And we have proven
that when we and states dedicate ourselves to changing the delivery of
care, we get results.Consider the role Medicaid has played in
supporting seniors and people with disabilities to receive care in
their communities. Twenty years ago, more than 80 percent
of Medicaid spending on long-term services was on institutional care. Now,
thanks to CMS’ and states’ work to make more options available,
community-based care has significantly increased.Medicaid has also
partnered with several national organizations at the provider, consumer
and state levels to help us think through ways to improve both the
delivery and quality of care Medicaid and CHIP provides, such as the March
of Dimes, the Medicaid State Dental Association and seven academic Centers
of Excellence.
- A platform for
innovation.
Medicaid innovates more quickly when states have the tools to respond to
the needs of their residents. To help support these delivery
system reforms through improvements to the coordination of
patient care, states, with the support of CMS, are working to
update legacy IT systems to ones that leverage proven IT
methods. This is key in helping to deploy tools, such as
electronic health records, that improve the coordination of patient
care, further supporting innovative efforts that lead to smarter
spending and healthier people.
Most importantly, Medicaid is there
when you need it, for working class families, working Americans, people falling
on temporary hard times, or living with a disability. Take Todd, a full
time student with two part time jobs in Utah who was recently profiled
by the Kaiser Family Foundation. He and his wife, Erin, were uninsured
but had a new baby. They learned that Erin and their baby Jane were eligible
for Medicaid. “When we found out that my wife and Jane would be covered, it
definitely felt like a burden lifted a weight off our shoulders,”
Todd said. “We don’t make enough to really take care of ourselves the way
we would like to.”
It's because of people like Todd
and Erin and people like you that we have invested so heavily and
thoughtfully in Medicaid and put forward the rules we have today, which will
also support physicians and hospitals and states in improving service, quality
and health for millions of Americans.
###
To read the final rule, please visit: Medicaid Managed Care (CMS-2390-F) at Federal Register: https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-09581.pdf and 05/06/2016 will available online at http://federalregister.gov/a/2016-09581
Additional facts sheets will be
available this afternoon at https://www.medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/managed-care/managed-care-site.html
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