Tag: Medicaid Reform

 
 

MM Curator summary

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[MM Curator Summary]: Far left extremists want to use NFIB vs Sebelius as precedent for not being able to do national Medicaid work requirements.

 
 

 
 

 
 

Clipped from: https://www.beckerspayer.com/payer/viewpoint-federal-medicaid-work-requirements-are-unconstitutional.html

Forcing states to implement Medicaid work requirements would fail basic constitutionality tests, a group of health policy experts wrote in Health Affairs. 

In the article published May 3, professors at the Milken School of Public Health at George Washington University in Washington, D.C., argued federal work requirements for the program would “utterly depart from Medicaid’s tradition of providing coverage to people at their most vulnerable.” 

House Republicans have proposed Medicaid work requirements as part of their proposal to raise the debt ceiling into next year. The bill passed in the House April 26, though the bill is unlikely to pass the Democratic-controlled Senate. 

The proposal would result in 600,000 people losing Medicaid coverage, according to estimates from the Congressional Budget Office. 

In 2011, the Supreme Court ruled the federal government could not require states to expand Medicaid under the ACA. The same standard should apply to requiring states to add work requirements, the authors wrote in Health Affairs. 

“In short, Medicaid is all about getting health care to eligible people when they need it; this is its core purpose,” the authors wrote. “By imposing a work requirement as a condition of state entitlement to payment, the bill would completely undo this foundational feature by withholding federal funding for reasons unrelated to basic eligibility factors and the need for care.” 

Some states have moved to implement work requirements in their Medicaid programs. Arkansas Gov. Sarah Sanders is asking the federal government for a waiver to implement work requirements for Medicaid recipients. 

Arkansas implemented work requirements for Medicaid recipients in 2018. A federal judge blocked the requirements in 2019. 

Georgia is set to implement work requirements for Medicaid recipients in July.  

Read more here. 

Subscribe to the following topics: medicaidmedicaid work requirementsdebt ceilingacasupreme court

 
 

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: CMS thinks it will open up the black boxes of provider pricing and the true depth of the network access problem with this new rule. Cute.

 
 

 
 

 
 

Clipped from: https://www.healthcarefinancenews.com/news/cms-proposes-national-standards-medicaid-and-chip

The proposed rules would establish wait times and require states to disclose provider payment rates in fee-for-service and managed care.

 
 

Photo: SDI Productions/Getty Images

The Centers for Medicare and Medicaid is proposing new standards and requirements for Medicaid or CHIP services, including ones for in-home and community-based services. 

Among other standards, the proposed rule would establish national maximum standards for certain appointment wait times for Medicaid or CHIP managed care enrollees and require disclosure of provider payment rates in both fee-for-service and managed care.

CMS on Thursday unveiled the two notices of proposed rulemaking: Ensuring Access to Medicaid Services (Access NPRM); and Managed Care Access, Finance, and Quality (Managed Care NPRM).If adopted as proposed, the rules would establish historic national standards for access to care, regardless of whether that care is provided through managed care plans or directly by states through fee-for-service, CMS said. Over 70% of people with Medicaid or CHIP coverage are enrolled in managed care plans.

WHY THIS MATTERS

Together, the Access NPRM and Managed Care NPRM include new and updated proposed requirements for states and managed care plans that would establish tangible, consistent access standards, and a consistent way to transparently review and assess Medicaid payment rates across states, CMS said. 

The rules propose:

• Transparency for Medicaid payment rates to providers, including hourly rates and compensation for certain home care and other direct care workers. 
  
• Standards to allow enrollees to compare plans based on quality and access to providers through the state’s website. 
  
• To establish national maximum standards for certain appointment wait times for Medicaid or CHIP managed care enrollees; stronger state monitoring and reporting requirements related to access and network adequacy.
  
• To require states to conduct independent secret shopper surveys of Medicaid or CHIP managed care plans to verify compliance with appointment wait time standards and to identify where provider directories are inaccurate.
  
• To create new payment transparency requirements for states by requiring disclosure of provider payment rates in both fee-for-service and managed care, with the goal of greater insight into how Medicaid payment levels affect access to care.
  
• To establish additional transparency and interested party engagement requirements for setting Medicaid payment rates for home and community-based services (HCBS), as well as a requirement that at least 80% percent of Medicaid payments for personal care, homemaker, and home health aide services be spent on compensation for direct care workers (as opposed to administrative overhead or profit).
  
• Create timeliness-of-access measures for HCBS and strengthen safeguards to ensure beneficiary health and welfare as well as promote health equity. 
  
• Strengthen how states use state Medical Care Advisory Committees, through which stakeholders provide guidance to state Medicaid agencies about health and medical care services, to ensure all states are using these committees optimally to realize a more effective and efficient Medicaid program that is informed by the experiences of Medicaid beneficiaries, their caretakers and other interested parties.
  
• Require states to conduct enrollee experience surveys in Medicaid managed care annually for each managed care plan to gather input directly from enrollees.
  
• Establish a framework for states to implement a Medicaid or CHIP quality rating system, a “one-stop-shop” for enrollees to compare Medicaid or CHIP managed care plans based on quality of care, access to providers, covered benefits and drugs, cost and other plan performance indicators. 
  

THE LARGER TREND

Medicaid is the single largest health coverage program in the United States, covering nearly one in four Americans and over half of all children in the country.

Medicaid and CHIP provide benefits with little to no out-of-pocket costs for over 92 million people. Many of those enrolled in Medicaid or CHIP come from underserved communities whose populations have disproportionately higher uninsured rates, and who often experience chronic health issues. 

ON THE RECORD

“The Biden-Harris Administration has made clear where we stand: we believe all Americans deserve the peace of mind that having health care coverage brings,” said HHS Secretary Xavier Becerra. “We are proposing important actions to remove barriers to care, engage consumers, and improve access to services for all children and families enrolled in these critical programs. One in four Americans and over half of all children in the country are enrolled in Medicaid or CHIP – and the Biden-Harris Administration is committed to protecting and strengthening these programs for future generations.” 

“Having healthcare coverage is fundamental to reducing health disparities, but it must go hand-in-hand with timely access to services. Connecting those priorities lies at the heart of these proposed rules,” said CMS Administrator Chiquita Brooks-LaSure. “With the provisions we’ve outlined, we’re poised to bring Medicaid or CHIP coverage and access together in unprecedented ways – a key priority that’s long overdue for eligible program participants who still face barriers connecting to care.” 

 
 

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org

 
 

MM Curator summary

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[MM Curator Summary]: So it re-starts where it began.

 
 

Clipped from: https://www.kansascity.com/news/politics-government/national-politics/article274946496.html

National Politics

By BRUCE SCHREINER and DYLAN LOVAN Associated Press

Updated May 02, 2023 8:51 PM

Several Republican gubernatorial candidates offered support for imposing work requirements for some able-bodied Kentucky adults receiving Medicaid health coverage as they met in a high-stakes debate on statewide television Monday night, about two weeks before the state’s primary election.

The 90-minute event on Kentucky Educational Television marked the long-awaited first faceoff between Attorney General Daniel Cameron and former ambassador Kelly Craft on a debate stage. The two rivals — at the center of an increasingly combative GOP contest — quarreled over campaign contributions and a U.S. Justice Department report that found Louisville police engaged in a pattern of violating constitutional rights and discrimination against the Black community.

The debate featured five candidates — Cameron, Craft, state Agriculture Commissioner Ryan Quarles, Somerset Mayor Alan Keck and retired attorney Eric Deters. They’re among a dozen candidates in all who are competing for the state’s GOP nomination for governor in the May 16 primary. Democratic Gov. Andy Beshear is seeking reelection to a second term, in a campaign drawing national attention to see if the popular incumbent can overcome his party’s struggles in the GOP-trending Bluegrass State.

The Republican rivals spent considerable time delving into the past, focusing their attacks on restrictions imposed by Beshear during the COVID-19 pandemic. They accused the governor of overstepping his authority, with Quarles pointedly saying that Beshear “ruled by a committee of one.” Beshear says his actions saved lives. The pandemic is blamed for more than 18,000 deaths in Kentucky.

The GOP candidates also delved into a range of issues including education, tax-and-spending priorities, gun rights and putting conditions on some adults to be eligible for Medicaid coverage. Medicaid is a joint federal and state health care program for the poor and disabled.

Cameron offered more details about his support for Medicaid-related work requirements for able-bodied Kentucky adults — an issue likely to reignite during the general election campaign. Cameron said that Medicaid should be “a transitory program unless medically necessary or means tested.”

 
 

Cameron offered a plan that sounded similar to what former Republican Gov. Matt Bevin unsuccessfully tried to implement in Kentucky. Cameron said the requirement could include such other conditions as volunteer work to qualify for Medicaid.

“If you are a mother who has a baby at home and aren’t able to get out into the workforce yet, that is OK,” Cameron said. “This is not targeted or applying to you.”

Quarles and Craft sounded supportive of the Medicaid proposal as well.

“Whenever people are healthy, able bodied Kentuckians, it actually takes away from those that truly do need benefits like the disabled and those that truly need help,” Quarles said.

Craft said Medicaid coverage should be “a pathway to take them from poverty to work.” Craft mentioned either work, study or community service standards for some recipients. Craft is a former U.S. ambassador to the United Nations.

Medicaid became a flash point during the state’s 2019 gubernatorial campaign, when Beshear narrowly defeated Bevin. After taking office, Beshear rescinded efforts by Bevin to set work requirements for some able-bodied adults to receive Medicaid coverage. At the time, Beshear referred to his action as the “moral, faith-driven thing to do.” Advocates have said work requirements would become one more hoop for low-income people to jump through, and many could be denied coverage because of technicalities and challenging new paperwork.

During a discussion about education, Quarles said it’s important that Kentucky get a good return on its investments in schools. Such reviews should include public universities and colleges, he said.

“We need to make sure that the cost of education is affordable, and that our educational programs are aligned with what employers are looking for,” Quarles said.

Meanwhile, the escalating back-and-forth attacks that have focused on Craft and Cameron — and their surrogates — spilled over into the debate.

Craft borrowed an attack from one of her TV ads, criticizing Cameron for not opposing the U.S. Justice Department’s investigation of Louisville Police practices.

“What does say about backing the blue?” Craft asked.

The federal investigation was launched after the fatal police shooting of Breonna Taylor, and found a years-long pattern of discriminatory practices by the department.

Cameron countered that he had the support of more than 100 law enforcement officials. Cameron called Craft “naive” for believing that he “could have stood at the Ohio River and told the Department of Justice they couldn’t come into the state.”

Deters was critical of Craft after she said she was not aware of her husband’s contributions to a political action committee that supported her.

“Her husband is financing her campaign and they’re trying to buy the governorship,” Deters said.

After one prolonged round of joisting that featured Cameron, Craft and Deters, Keck expressed disgust. The Somerset mayor said: “The last 10 minutes are why people are sick of politics in America.”

This story was originally published May 1, 2023, 9:17 PM.

 
 

MM Curator summary

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[MM Curator Summary]: In which an opiner suggests the unthinkable.

 
 

Clipped from: https://www.washingtonexaminer.com/restoring-america/fairness-justice/dont-expand-medicaid-twe will seeo-noncitizens

 
 

About one in five Americans are enrolled in Medicaid and the program now makes up about a quarter of all state spending. (AP Photo)

Last week, the Biden administration released a plan that would open up Medicaid and Obamacare to nearly 580,000 undocumented immigrants. Never mind that the federal deficit is projected to reach $1.4 trillion this year. What’s another few billion dollars?

The proposed rule centers around the Deferred Action for Childhood Arrivals program, which allows undocumented immigrants who came to the United States as children to live and work here without being deported. DACA recipients aren’t citizens. So they’re not eligible to enroll in most government health programs, like Medicaid and Obamacare. President Joe Biden wants to change that. And he wants to do so at a time when federal spending on health insurance is already spiraling out of control. Medicaid, for instance, cost $734 billion in 2021, the latest year for which data are available. That’s a nearly 10% increase from the year before and amounts to more than one of every six dollars the nation spent on healthcare in 2021.

Or consider Obamacare. The Inflation Reduction Act extended more generous subsidies for exchange coverage through 2025 at a cost of $64 billion . Extending them permanently, which is what Democrats are hoping to do, would increase the federal deficit by nearly $248 billion between 2023 and 2032. It’s not yet clear how much expanding federal healthcare to DACA recipients would cost. But one need only look to California to make an educated guess.

The state has committed to offering Medicaid, called Medi-Cal in California, to all low-income adults aged 26 to 49 regardless of immigration status starting in 2024 — about 700,000 people. (California already provides Medi-Cal to undocumented children and seniors.) The cost of the expansion is expected to be $844.5 million in 2023-24, $2.1 billion the following year, and $2.5 billion annually thereafter.

Extrapolate those costs to the entire country, and Biden’s proposed expansion of federal health coverage to DACA recipients stands out as yet another exorbitant expansion of government healthcare programs — one that taxpayers simply can’t afford.

CLICK HERE TO READ MORE FROM RESTORING AMERICA

Sally C. Pipes is president, CEO, and Thomas W. Smith fellow in Health Care Policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All (Encounter 2020). Follow her on Twitter @sallypipes.

 
 

MM Curator summary

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[MM Curator Summary]: Forbes kindly points out that the 18M are no longer eligible and have lots of protections to help them as they exit the program for which they are… no longer eligible.

 
 

Clipped from: https://www.forbes.com/sites/theapothecary/2023/05/02/cleaning-up-medicaid-rolls-after-covid/?sh=4371c5f83003

Today, Paragon Health Institute released a new report, Pandemic Unwinding: How States Should Clean Up Their Medicaid Rolls.

Medicaid is a welfare program for low-income Americans. But, because of policies related to the COVID public health emergency, more than 20% of Medicaid enrollees no longer meet the criteria for program eligibility. States have not conducted redeterminations of Medicaid enrollees’ eligibility in more than three years.

States have an obligation to move as quickly and smartly as possible to begin cleaning up their Medicaid rolls. Doing so would represent an important first step toward rebuilding public trust, protecting taxpayers, and preserving resources for the country’s most vulnerable.

I coauthored this report with Gary Alexander, who led two state health and human services departments, and research fellow Nic Horton. The importance of Medicaid redeterminations was evidenced by yesterday’s Wall Street Journal op-ed by Arkansas Governor Sarah Huckabee Sanders entitled, “Arkansas Gets Medicaid Back to Normal.” The Paragon report provides a case study of Arkansas’s approach to redeterminations and contains seven steps that states should take to perform expedited and efficient redeterminations.

According to the Congressional Budget Office, roughly 20 million Americans have multiple sources of coverage with the most common being employer coverage and Medicaid. As a result, taxpayers are making sizeable payments to health insurers for many Medicaid enrollees who have other sources of coverage and who should not be on welfare. Moreover, public resources are being expended for people who likely need the program less than others who rely on it to pay their health care expenses.

Here are the five key takeaways from the paper:

1. The continuous enrollment requirement for Medicaid during the COVID-19 public health emergency has led to upwards of 18 million Medicaid enrollees who do not meet eligibility requirements for the program.

2. As of April 1, 2023, states have resumed regular eligibility redeterminations to preserve Medicaid for those who truly need the program and to protect taxpayers. States should prioritize resources and start with reviews of those most likely to now be ineligible.

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3. States have an incentive to act expeditiously, as enhanced federal COVID funding for Medicaid has already begun winding down and will be gone by the end of 2023.

4. The vast majority of people enrolled in Medicaid who are ineligible already have other sources of coverage or will transition to other sources of coverage when their Medicaid enrollment ends. For example, a study from the Urban Institute found that only one percent of removed enrollees would not qualify for other forms of subsidized coverage.

5. There are numerous protections for people who are removed from the program and who are still eligible, including retroactive Medicaid coverage that pays for three months of past medical expenses.

Even before the pandemic, improper Medicaid enrollment was the leading cause of improper payments in federal health programs, including Medicare. This was a problem emanating from the excessive federal reimbursement of state expenditures on Medicaid recipients enrolled under the Affordable Care Act (ACA). With University of Kentucky economist Aaron Yelowitz, I wrote about how the ACA led to significant improper enrollment and spending in Medicaid in two Wall Street Journal pieces (“ObamaCare’s Medicaid Deception” and “Why Obama Stopped Auditing Medicaid“) as well as a Mercatus research paper. Thus, there were many ineligible Medicaid enrollees when the COVID continuous coverage requirements commenced.

In the report, we discuss how rules from both the Obama and Biden administration made it more likely for ineligible people to stay on Medicaid and more difficult for states to remove ineligible recipients from Medicaid, in part by reducing the frequency of state eligibility redeterminations. Importantly, much of the media’s focus on Medicaid redeterminations fails to appreciate how easy it is for people who are eligible for Medicaid to enroll or re-enroll in the program. As we discuss in the report, two major protections are retroactive eligibility and hospital presumptive eligibility.

• Retroactive eligibility: Individuals who qualify for Medicaid can enroll and have their medical expenses covered by taxpayers retroactively so long as they were eligible when the services were received. If individuals are incorrectly removed, they can re-enroll in the program and still have their expenses covered, with up to three months of expenses paid by Medicaid.

• Hospital Presumptive Eligibility (PE): PE is an expedited Medicaid application process through the hospital that permits a Medicaid determination based on only a few questions about income and household size and without verification. If individuals meet these basic and initial requirements, they are immediately presumed Medicaid eligible. They receive temporary coverage pending completion of a full eligibility review. This means that a person who is disenrolled often finds it easy to get back on the program through PE when receiving medical services.

 
 

MM Curator summary

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[MM Curator Summary]: Turns out the Aace in the hole used by far left-wing activists to force Medicaid expansion is really a Joker.

 
 

Clipped from: https://www.wsj.com/articles/medicaid-expansion-wont-save-rural-hospitals-obama-care-fraud-dependency-e9ad20c7

But it has disastrous consequences for state budgets and fosters high levels of dependency.

Democrats think they’ve found the key to convincing Republican states to expand Medicaid and cover millions more able-bodied adults in the government-run health-insurance program. Over the past few years, Democrats have claimed that refusing to accept ObamaCare’s central policy will force the closure of rural hospitals, hurting GOP states and voters the most. This tug-at-the-heartstrings message has swayed Republican-dominated states such as South Dakota, Missouri and, as of late March, North Carolina to expand Medicaid. But it’s a lie.

I have analyzed every hospital closure since 2014 when ObamaCare went into effect. Medicaid expansion has failed to halt rural hospital closures, and in some cases it contributes to them. The reason is simple: Medicaid is so poorly run that it often adds financial burdens to hospitals. The 10 Republican-led states that haven’t adopted this policy would be wise to hold their ground, given that Medicaid expansion also has disastrous consequences for state budgets and fosters historic levels of government dependency.

 
 

Here are the facts. Since 2014, dozens of hospitals have closed in states that haven’t expanded Medicaid. Yet their stated reasons almost always have nothing to do with Medicaid expansion. Damage from natural disasters, declining business and fraud, among many other factors, have caused hospitals to close. Only four hospitals in nonexpansion states directly attributed their closures to a lack of Medicaid expansion. Two of them later were alleged to have engaged in wide-scale fraud and financial mismanagement, casting doubt on their earlier statements.

Even more telling is what happened in the nearly 40 states that did expand Medicaid before the start of this year. Despite the assurances of liberal activists, nearly 50 hospitals have closed in these states since expansion passed, including more than a dozen in rural areas. Missouri voted to expand Medicaid by ballot initiative in August 2020, with implementation beginning a little more than a year later. Yet two rural hospitals closed in September 2022, well after expansion took effect.

 
 

The situation will surely worsen. According to data from the Center for Healthcare Quality and Payment Reform, 1 in 4 rural hospitals in expansion states are still at risk of closure. A 2019 Navigant study found that the top five states at risk of losing community-essential rural hospitals are all expansion states.

This is exactly what Medicaid expansion was supposed to prevent, yet expansion itself is driving this crisis in rural and urban hospitals alike. The program’s reimbursement rates are about 60% of what private health insurance pays, often leaving hospitals with large losses on Medicaid patients. Nationwide, more than 18 million able-bodied adults and counting have enrolled in the program due to expansion, and each new recipient potentially adds red ink to a hospital’s balance sheet.

Rural hospitals typically struggle financially as it is, and Medicaid expansion can push them into insolvency. But the problem isn’t limited to rural hospitals. Pennsylvania expanded Medicaid in 2015 and Philadelphia’s Hahnemann Hospital closed in 2019 because of what the Philadelphia Inquirer called a “heavy reliance on Medicaid.”

Despite these closures, hospital advocacy groups have joined Democrats in vigorously demanding expansion. The promise of federal money in the short term—and the resulting bonuses and pay bumps for hospital executives—is apparently more important than future stability.

Democrats won’t stop until they convince all 50 states to expand Medicaid. As one activist told the New York Times in March, “this argument about rural hospital closures has been an incredibly compelling argument to voters.” That same story, which focused on Mississippi, was titled “A State’s Choice to Forgo Medicaid Funds Is Killing Hospitals.” Mississippi and Alabama are likely the next two states in Democrats’ sights.

The remaining Republican-led states shouldn’t fall for it. By not expanding Medicaid, they are likely saving rural hospitals from even worse financial pressure, while protecting taxpayers from enormous losses and saving able-bodied adults from government dependence. In these states, at least, the truth about Medicaid expansion still prevails.

Mr. Dublois is data and analytics director at the Foundation for Government Accountability.

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From <https://www.wsj.com/articles/medicaid-expansion-wont-save-rural-hospitals-obama-care-fraud-dependency-e9ad20c7>

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Welcome the next cohort of MACPAC(kers).

 
 

https://www.gao.gov/press-release/gao-makes-macpac-appointments,-designates-vice-chair-0

 
 

 
 

Press Release WASHINGTON, D.C. (May 1, 2023)—Gene L. Dodaro, Comptroller General of the United States and head of the U.S. Government Accountability Office (GAO), today announced the appointment of six new members to the Medicaid and CHIP Payment and Access Commission (MACPAC). He also named the Commission’s Vice Chair.

“I’m pleased to announce the newest members of this important health care commission,” Dodaro said. “These outstanding individuals are exceptionally well-qualified to serve and provide Congress with expert advice on both Medicaid and the Children’s Health Insurance Program (CHIP).”

The newly appointed members are Timothy Hill, Carolyn Ingram, Patti Killingsworth, Adrienne McFadden, and Jami Snyder. Their terms will expire in April 2026. In addition, John B. McCarthy was newly appointed to serve out the remaining term of Laura Herrera Scott, which will expire in April 2024. Current member Robert Duncan has been named the Commission’s Vice Chair.

The Children’s Health Insurance Program (CHIP) Reauthorization Act of 2009 established MACPAC to review Medicaid and CHIP access and payment policies and to advise Congress on issues affecting Medicaid and CHIP. The Act directs the Comptroller General to appoint MACPAC’s members. Brief biographies of the new commission members and the Commission Vice Chair follow.

New Commission Members:

 
 

 
 

Timothy Hill, MPA, is Vice President for Client Engagement at the American Institutes for Research (AIR), where he provides leadership and strategic direction across a variety of health-related projects. Prior to joining AIR, Mr. Hill held several executive positions within the Centers for Medicare & Medicaid Services (CMS), including as a Deputy Director of the Center for Medicaid and CHIP Services, the Center for Consumer Information and Insurance Oversight, and Center for Medicare. Mr. Hill earned his bachelor’s degree from Northeastern University and his master’s degree from the University of Connecticut.

 
 

Carolyn Ingram, MBA, is an Executive Vice President of Molina Healthcare, Inc., which provides managed health care services under the Medicaid and Medicare programs, as well as through state insurance marketplaces. Ms. Ingram is also the Plan President for Molina Healthcare of New Mexico and the Executive Director of the Molina Healthcare Charitable Foundation. Previously, Ms. Ingram served as the Director of the New Mexico Medicaid program, where she launched the state’s first managed long-term services and supports program. She also held prior leadership roles, including Vice Chair of the National Association of Medicaid Directors and Chair of the New Mexico Medical Insurance Pool. Ms. Ingram earned her bachelor’s degree from the University of Puget Sound and her master of business administration from New Mexico State University.

 
 

Patti Killingsworth is the Senior Vice President of Long Term Services and Supports (LTSS) Strategy at CareBridge, a value-based healthcare company dedicated to supporting Medicaid and dual eligible beneficiaries receiving home and community-based services. Ms. Killingsworth is a former Medicaid beneficiary and lifelong family caregiver with 25 years of Medicaid public service experience, most recently as the longstanding Assistant Commissioner and Chief of LTSS for TennCare, the Medicaid agency in Tennessee. Ms. Killingsworth received her bachelor’s degree from Missouri State University.

 
 

John B. McCarthy, MPA, is a Founding Partner at Speire Healthcare Strategies, which helps public and private sector entities navigate the healthcare landscape through the development of state and federal health policy. Previously, he served as the Medicaid Director for both the District of Columbia and Ohio, where he implemented a series of innovative policy initiatives that modernized both programs. He has also played a significant role nationally, serving as Vice President of the National Association of Medicaid Directors. Mr. McCarthy holds a master’s degree in public affairs from Indiana University’s Paul H. O’Neill School of Public and Environmental Affairs.

 
 

Adrienne McFadden, MD, JD, is the Chief Medical Officer of Medicaid at Elevance Health, where she serves as the strategic clinical thought leader for the Medicaid line of business. Previously, Dr. McFadden was the Chief Medical Officer at Buoy Health, a virtual health service created to support patient decision making. After beginning her career in emergency medicine, Dr. McFadden has held multiple executive and senior leadership roles including Vice President for Medicaid Clinical at Humana, Inc.; Director of the Office of Health Equity at the Virginia Department of Health; and inaugural Medical Director of the South University Richmond Physician Assistant Program. Dr. McFadden received her medical and law degrees from Duke University.

 
 

Jami Snyder, MA, is the President and Chief Executive Officer of JSN Strategies LLC, where she provides health care-related consulting services to a range of public and private sector clients. Previously, she was the Arizona cabinet member charged with overseeing the state’s Medicaid program. During her tenure, Ms. Snyder spearheaded efforts to stabilize the state’s health care delivery system during the public health emergency and advance the agency’s Whole Person Care Initiative. Ms. Snyder also served as the Medicaid director in Texas and as the President of the National Association of Medicaid Directors. Ms. Snyder holds a master’s degree in political science from Arizona State University.

Commission Vice-Chair:

 
 

Robert Duncan, MBA, is Executive Vice President and Chief Operating Officer of Connecticut Children’s. Previously, he served as Executive Vice President of Children’s Wisconsin and the President of Children’s Service Society, a large social service agency that provides foster care and adoption, mental health, and parental support services to children and families across the state. Earlier, he served as both the Director of the Tennessee Governor’s Office of Children’s Care Coordination and the Director of CoverKids, Tennessee’s CHIP program. Mr. Duncan received his master of business administration from the University of Tennessee at Martin.

For more information about MACPAC, contact Kate Massey, MACPAC’s executive director, at (202) 350-2000. Other questions should be directed to Chuck Young in GAO’s Office of Public Affairs at (202) 512-4800. 

 
 

From <https://www.gao.gov/press-release/gao-makes-macpac-appointments,-designates-vice-chair-0>

 
 

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: We sort of don’t have a plan to keep Medicare/Medicaid integration going.

 
 

 
 

Clipped from: https://healthpayerintelligence.com/news/how-to-protect-integration-progress-as-medicare-medicaid-plans-sunset

With Medicare-Medicaid plans set to sunset by the end of 2025, states, CMS, Congress, and other stakeholders must take steps to protect the Medicare-Medicaid integration progress.

Source: Getty Images

 
 

By Kelsey Waddill

May 03, 2023 – As CMS sunsets the Medicare-Medicaid plan model, Congress and the agency will need to take steps to expand the Medicare-Medicaid Coordination Office (MMCO) oversight capabilities and protect the previous years’ Medicare-Medicaid integration progress, researchers explained in a Health Affairs article.

CMS is sunsetting the Medicare-Medicaid plan model nationwide. The agency found that the program was inconsistent. In some cases it increased utilization while in other cases it decreased utilization. The Medicare-Medicaid plan will be dissolved nationwide by the end of December 2025.

States will have to determine how to transition their Medicare-Medicaid plan populations into meaningfully integrated dual eligible special needs plans, such as highly integrated dual eligible special needs plans (HIDE SNP) and fully integrated dual eligible special needs plans (FIDE SNP).

There are 11.5 million individuals with access to a dual eligible special needs plan or Medicare-Medicaid plans. Less than half are enrolled in one of these options (5.1 million). The sunsetting of the Medicare-Medicaid plan model in one state (California) drove down enrollment in meaningfully integrated programs.

Some states have models that will provide a more natural transition into meaningfully integrated plans. For example, eight states offer a capitated Medicare-Medicaid plan and certain counties in two of these states offer parallel Medicare-Medicaid plans and FIDE SNPs. By expanding the FIDE SNPs, the plans could absorb Medicare-Medicaid plan beneficiaries.

Most states will have to design a pathway from Medicare-Medicaid plans to meaningfully integrated plans.

Also, the sunsetting of the Medicare-Medicaid plan model may require CMS to rethink the role of the MMCO.

The researchers pointed out that the MMCO’s functions extend beyond the Medicare-Medicaid plans. The office should continue to be responsible for overseeing Medicare-Medicaid integration and it is the only office that is dedicated to both programs, as opposed to other oversight bodies that focus on either Medicare or Medicaid.

“As the end of the MMP nears and the future of MMCO is uncertain, it is important to ensure Medicare-Medicaid integration successes are not lost,” the researchers underscored.

They suggested four administrative and regulatory changes that could support integration of Medicare and Medicaid as CMS sunsets the Medicare-Medicaid plans.

First, policymakers should address the role of MMCO and the extent of its authority. MMCO leaders have expressed that they do not have the power to engage more broadly in Medicare-Medicaid integration. But the researchers urged Congress to formalize MMCO’s authority over the Financial Alignment Initiative, dual eligible special needs plan endeavors, and other related programs.

Second, as states are required to sunset their Medicare-Medicaid plans, they should also be required to set up integrated programs.

“States face competing priorities and political pressures that inhibit a shift to an integrated program. Absent a mandate, dual eligible individuals in many states and counties will continue to lack access to an integrated option,” the researchers stated.

States can use dual eligible special needs plan State Medicaid Agency Contract (SMAC). Additionally, they should be required to formulate an integration plan and should receive planning grants and technical assistance, with MMCO oversight.

Third, policymakers should remove the financing and payment barriers to integration. Funds should be fungible between Medicare and Medicaid services and siloes should be disintegrated. States should be allowed to participate in Medicare savings that are a result of integration investments.

Finally, lawmakers and CMS should create training of enrollment support providers so that they can share the value of integration. There should also be incentives for enrolling dual eligibles in meaningfully integrated programs.

“CMS should work with the Administration for Community Living (ACL) and states to ensure the aging and disability network (including SHIPs) is equipped to serve dual eligible individuals, and Congress should ensure sufficient resourcing,” the researchers added.

For payers who are considering entering the dual eligible market during this sunset period, separate research has outlined five factors to keep in mind.

 
 

 
 

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Let’s try this maybe in a way that doesn’t rely on CMS or SCOTUS.

 
 

 
 

Clipped from: https://www.washingtonpost.com/business/2023/04/11/gop-medicaid-food-stamps-work/

The demand from House Speaker Kevin McCarthy comes as the White House rejects talks on policies that could cut benefits to low-income Americans

House Speaker Kevin McCarthy (R-Calif.) at a bill-signing ceremony in March. GOP leaders are looking at proposals to require recipients of some federal aid to work. (Jabin Botsford/The Washington Post)

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House Republicans are eyeing new work requirements for millions of low-income Americans who receive health insurance, money to buy food and other financial aid from the federal government, reprising the party’s historic crusade against welfare as some lawmakers seek new ways to slash spending.

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In recent weeks, the GOP has focused its attention on two anti-poverty programs: Medicaid, which enrolls the poorest families in health insurance, and food stamps, which provide grocery benefits to those in need. Top lawmakers including House Speaker Kevin McCarthy (R-Calif.) have publicly endorsed rules that could force some enrollees to find a job and work longer hours — or risk losing the government’s help entirely.

The demands largely come in the context of a brewing fight over the federal budget. Many Republicans have said that federal aid programs offer a way for policymakers to boost U.S. workforce participation while saving Washington money — a stance that infuriates Democrats, aid workers and others, who say such changes could harm vulnerable families still reeling since the coronavirus pandemic.

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The debate in some ways resembles the Republican-led campaign against so-called welfare queens in the 1990s, when a politically resurgent GOP — then under the leadership of House Speaker Newt Gingrich — secured a dramatic restructuring of the government’s social safety net. The resulting overhaul, enacted by President Bill Clinton, slashed cash benefits for millions of Americans in ways that GOP leaders now cite as a model.

“I don’t think hard-working Americans should be paying for all the social services for people who could make a broader contribution and instead are couch potatoes,” Rep. Matt Gaetz (R-Fla.), a member of the far-right House Freedom Caucus, said at a news conference last month.

At the center of the standoff is the debt ceiling, the statutory limit on how much the U.S. government can borrow to pay its bills. Lawmakers must raise that cap as soon as June or risk a federal default — an economic calamity that GOP leaders have tried to exploit in hopes of advancing their agenda.

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In a letter published late last month, McCarthy called on President Biden to negotiate and spelled out his party’s latest demands. That included steep spending cuts and new policies “strengthening work requirements for those without dependents” — a reference to children — citing the fact that Biden supported the welfare-to-work approach adopted under Clinton in the ’90s.

Biden has refused to haggle over the debt ceiling and instead demands that Republicans raise it and preserve the country’s credit without conditions. The president has expressed a willingness to discuss broader fiscal issues with McCarthy, but White House aides have outright rejected any changes to food stamps and Medicaid that reduce enrollment.

“The President has been clear that he will oppose policies that push Americans into poverty or cause them to lose health care,” White House spokesman Michael Kikukawa said in a statement. “That’s why he opposes Republican proposals that would take food assistance and Medicaid away from millions of people by adding burdensome, bureaucratic requirements.”

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Still, top Republicans have unveiled a battery of proposals, including one targeting Medicaid, hoping to deliver on a long-sought conservative goal to add work requirements to the insurance program.

In February, Gaetz released legislation that would deny benefits to able-bodied adults unless they work for 120 hours per month, volunteer or participate in a work program for 80 hours, or participate in a combination of those activities. The congressman did not respond to a request for comment.

It is unclear whether other Republicans would support that approach. Gaetz’s bill does not yet appear to have any co-sponsors, but the hard-right bloc to which he belongs, the House Freedom Caucus, generally endorsed work requirements in its own demand letter last month. The group didn’t specify any programs, but Rep. Scott Perry (R-Pa.), the caucus’s chairman, later told The Washington Post that he wants nationwide work requirements for Medicaid.

The new conservative push is especially potent because Republicans’ razor-thin House majority gives its hard-right faction powerful leverage. It also arrives at a tumultuous time for Medicaid, which saw enrollment balloon by about 30 percent at the height of the pandemic.

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During the crisis, lawmakers enacted temporary rules that essentially prevented states from culling their Medicaid rolls. But those prohibitions expired on April 1, opening the door for state health officials to begin reevaluating eligibility. Approximately 15 million low-income Americans are ultimately expected to lose their coverage as a result, including 6.8 million who still qualify for the program, according to federal estimates in August.

At the White House, Biden has leaned into health care as a campaign message ahead of a potential 2024 reelection bid. In an interview last month, his Medicaid chief criticized work requirements.

“On work requirements, I think the administration’s position is really clear about being very much concerned about putting up barriers to people getting coverage,” said Chiquita Brooks-LaSure, the administrator of the Centers for Medicare and Medicaid Services. “It’s critical that we have coverage in this country … and there are other ways to really address making sure that people are able to find employment.”

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The two parties have previously battled over work requirements in the safety net program. In 2018, the Trump administration issued optional guidance for states to implement work rules in Medicaid for the first time, contending it would incentivize healthy people to find employment. Democrats seized on the issue, arguing the policy would hurt vulnerable Americans and was designed to curtail Medicaid enrollment.

Thirteen states adopted such rules under President Donald Trump. Once Biden took office, however, his Medicaid agency quietly began to send letters rescinding states’ Medicaid work requirements, which already faced a flurry of legal challenges and weren’t in effect. Only one state, Arkansas, imposed a work requirement for a significant period. Over more than nine months, about 18,000 adults lost coverage for failing to comply with the rules, and only about 1,900 re-enrolled in the program before a federal judge blocked the work rules.

Since then, the state’s new governor, Sarah Huckabee Sanders (R), has said she will try again under different rules — while a work requirement in Georgia is slated to begin this summer. Nationally, Republicans have argued that such mandates could increase labor force participation, even as the unemployment rate remains low.

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“This is the perfect time to have work requirements because people are needed, they’re wanted,” said Rep. Brett Guthrie (R-Ky.), chairman of the House Energy and Commerce health subcommittee. “Wages are rising because there’s a shortage of workers, so it’s a good opportunity for people to better themselves moving forward.”

For some Republicans, though, the push doubles as an opportunity to reduce the federal debt, which exceeds $31 trillion. At a House hearing in early April, Rep. Darin LaHood (R-Ill.), the new chairman of the House Ways and Means subcommittee on work and welfare, stressed that lawmakers had to ensure more “accountability for federal taxpayer dollars.”

In doing so, Republicans have signaled their focus could be broad in scope, potentially including the benefits the government provides for housing, child care and other key services.

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“We should be exploring every possibility to get our fellow Americans back into the labor force, including strengthening work requirements across all government programs,” added Rep. Jason T. Smith (R-Mo.), the leader of the House Ways and Means Committee.

Tasked to prepare a spending blueprint for the 2024 fiscal year, the House Budget Committee last week specifically called attention to what it described as a “culture of government dependency,” citing an uptick in spending in Medicaid and other federal programs, including food stamps, unemployment insurance, disability benefits and tax credits for low-income parents with children.

The panel’s chairman, Rep. Jodey Arrington (R-Tex.), said in a previous interview that Republicans are “going to look at health care” with the goal of reducing costs, stressing that decisions “haven’t been made” about what to propose on Medicaid. Broadly, though, Arrington long has endorsed work requirements on aid programs, especially in the case of food stamps.

Formally known in Washington as the Supplemental Nutrition Assistance Program, or SNAP, food stamps provide lower-income households with an average of more than $230 each month for groceries, often paid through a debit card. Approximately 41 million people are currently enrolled in the program, according to the government.

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Under existing law, SNAP already requires many adults without children to seek employment and training. But GOP leaders argue that the rules are too lax, exempt too many beneficiaries from work and open the door for states to make too many exceptions.

One key bill from Rep. Dusty Johnson (R-S.D.), a top ally of McCarthy, would rewrite some of the program’s rules, chiefly by subjecting Americans without children between the ages of 49 and 65 to SNAP work requirements. (Current rules for these adults only apply up to 49.) The proposal, which has more than three dozen GOP co-sponsors, also would limit states’ ability to waive some of those rules.

“This is not about balancing the budget on the backs of anyone,” Johnson said in an interview, adding that there is “no reliable pathway out of poverty” that doesn’t involve work, education and training.

But the changes could force more than 10 million people off food stamps, according to the left-leaning Center on Budget and Policy Priorities, which estimates the cut would affect 1 in 4 SNAP recipients. Even those who retained monthly food aid could face additional hardship, because they could be forced to work longer hours in ways that affect their ability to care for their children, CBPP found.

Johnson disputed that analysis. Still, it could be the second blow to SNAP recipients in recent months, after Congress allowed a pandemic benefit program to expire in March, slashing millions of families food benefits by an average $82, according to the Food Research and Action Center. Some Republicans still have signaled discomfort over targeting SNAP in the ongoing budget debate.

Democrats, meanwhile, have pledged to oppose any such changes, setting up a clash that could come to head even if the GOP does not pursue changes in talks around the debt ceiling. Lawmakers also must act by Oct. 1 to approve legislation known as the Farm Bill, which authorizes a bevy of federal farm and nutrition-related programs.