Title: Making Medicaid Work MMW for the 21st Century
1Making Medicaid Work (MMW) for the 21st Century
- MCHP Partnership Meeting
- Nuts and Bolts on Medicaid Reform
- October 18, 2005
1
2Brief 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
3Making 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.
4Making 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
5Making 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
6Making 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.
7Key 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.
8Key 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
9Key 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.
10Key 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.
11Key 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
12Key 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
13Key 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.
14- For more information
- www.nashp.org
- Click on Making Medicaid Work for the 21st
Century - Or
- Nkaye_at_nashp. org