Making Medicaid Work MMW for the 21st Century

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Making Medicaid Work (MMW) for the 21st Century

• MCHP Partnership Meeting
• Nuts and Bolts on Medicaid Reform
• October 18, 2005

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Brief Background

• Medicaid has grown to become the largest health
  care program in America
• Over 50 million beneficiaries in 2004
• Over 300 Billion in state and federal spending
• Medicaids role is especially significant for
  children and low-income elderly and disabled
• Medicaid faces significant challenges due to its
  rules, requirements and costs to states
• Making Medicaid Work for the 21st Century is
  NASHPs Project to develop recommendations for
  improving Medicaid for the future

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Making Medicaid Work for the 21st Century

• NASHP convened a working group of stakeholders to
  systematically review Medicaid program to
  identify strengths and weaknesses and recommend
  improvements.
• Members included Health Secretaries, Medicaid
  Directors, Budget Officer, Long-term Care
  Directors, Legislators, Governors Advisors,
  Advocates, Providers, Experts.

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Making Medicaid Work for the 21st Century

• Timeline
• Project began in July 2003
• 3 in-person meetings 15 conference calls
• 6 issue briefs released between April and
  December 2004
• Final report released in January 2005
• Focus Eligibility, Benefits and Financing/Cost
  controls for acute and long-term care

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Making Medicaid Work for the 21st Century

• Funded
• Primarily by the David and Lucille Packard
  Foundation
• With support from AARP, Robert Wood Johnson
  Foundation, Agency for Health Care Research and
  Quality

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Making Medicaid Work for the 21st Century

• These recommendations
• Drawn from the experience and expertise of a
  diverse workgroup.
• Designed to help achieve Medicaid program goals
  determined by workgroup.
• Reflect the consensus or majority view of the
  workgroup but not necessarily the views of
  project funders or individual members.
• Are meant to be considered as an inter-related
  set which would best be considered as a whole.

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Key MMW Recommendations Eligibility (1)

• National Minimum Eligibility Standard
• Cover all people with incomes less than 100 of
  the Federal Poverty Level, with an enhanced
  federal match.
• Current minimum eligibility levels would be
  maintained for children ages 0-6 and pregnant
  women.
• Would cover 5.3 million new individuals, 4.0
  million uninsured
• Optional coverage States could extend
  eligibility above mandatory
• Phase-In States could phase up to national
  minimums.
• Cost Estimated at 16.6 billion/year when fully
  implemented
• If enhanced match for new eligibles, federal
  costs increase 11.2 billion, state 5.3 billion.

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Key MMW Recommendations Eligibility (2)

• Simplify Eligibility Allow states to base
  eligibility solely on income (or not)
• Long Term Care National minimums would apply.
• May establish a combined income and asset test
• May establish different functional eligibility
  requirements for institutional and community care

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Key MMW Recommendations Benefits

• Mandatory populations Current Medicaid rules
  would apply, including amount, duration, scope,
  comparability and cost-sharing
• Optional populations States could offer a less
  comprehensive package.
• Benefits would have to meet a benchmark
• Not required to offer long term care, can convert
  home and community-based waivers to program
• Cost sharing for optional groups States could
  require cost-sharing and premiums above levels
  required of mandatory groups.
• Choice of Program Parents can choose to enroll
  Medicaid eligible children in SCHIP.

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Key MMW Recommendations Financing

• Federal financing Medicaid should continue as a
  federalstate partnership with federal funds
  matching state expenditures with enhanced match
  for new beneficiaries.
• FMAP formula The formula for calculating the
  federal matching rate for each state (FMAP)
  should be changed to respond more quickly to
  economic downturns
• Financial integrity Clear, prospective Federal
  rules should define which state expenditures can
  qualify for federal matching funds in a way that
  assures fiscal integrity in all aspects of
  Medicaid financing.

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Key MMW Recommendations Cost Controls

• More flexibility to offer more restricted
  benefits with greater cost sharing for optional
  populations
• More options for premium assistance
• Ability to do selective contracting without a
  waiver
• Long Term Care State options
• to maintain expenditure caps
• to de-link nursing home and community LTC
  functional eligibility
• to require care managed delivery systems

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Key MMW Recommendations Waivers

• Waivers generally would be less needed
• Section 1115 Waiver Authority States should
  continue to have the opportunity to innovate in
  Medicaid structure, financing and delivery
  systems.
• The waiver process should be streamlined
• Section 1915(c) Waivers States should have the
  option to retain current HCBS waivers or to
  convert HCBS waiver programs to program status
• States should be able to extend
  Consumer-directed care and Money-follows the
  person programs

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Key MMW Recommendations Summary

• This is a significant time Key policy makers are
  working to reform Medicaid
• Eligibility
• Benefits
• Financing
• Waivers
• Making Medicaid Work for the 21st Century is
  intended to help inform the Medicaid reform
  discussion.

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• For more information
• www.nashp.org
• Click on Making Medicaid Work for the 21st
  Century
• Or
• Nkaye_at_nashp. org