The Medicaid Commission Health Reform Initiatives presented by Grace-Marie Turner Galen Institute June 13, 2007 Plenary--Turner--6.13@3.45pm MC

The Medicaid Commission Established by Secretary Leavitt in July 2005 15 voting members, 15 non-voting members Chairman: Former Tennessee Gov. Don Sundquist (R) Vice-chair: Former Maine Gov. Angus King (I) Other governors: Joe Manchin (D, WV) and Jeb Bush (R, FL) Public hearings held in Washington and around country

Two mandates September 1, 2005: Recommendations due on how to save $10 billion over 5 years; several ideas were included in the Deficit Reduction Act December, 2006: Final recommendations due on overall Medicaid reform. Available at: http://aspe.hhs.gov/medicaid/122906rpt.pdf

The goal Medicaid’s historic and most important job is to take care of the nation’s most vulnerable and truly needy citizens. Changes are needed to modernize Medicaid in order to improve the quality of care to beneficiaries and to make the program financially sustainable for the future.

Final recommendations Long-term care Benefit design Eligibility Health information technology Quality and care coordination

Long-term care Tax incentives for LTC insurance Tax breaks for those providing care Use of home equity to finance care Promote LTC Awareness Campaign Study alternative insurance Allow care in least-restrictive settings Plenary--Turner--6.13@3.45pm MC

Benefit design State flexibility Allow partnerships between states and beneficiaries Authority to replicate successful demos Enforce compliance with public notice and comment periods

Eligibility Simplify eligibility and allow states to redefine categories New subsidies to help working families purchase private health insurance Study a “scaled match” funding formula

Health information technologies EHRs by 2012 Allow 5-year savings window for budget States should include HIT specs in contracts HHS should promote HIT and interoperability HHS, Medicaid agencies and vendors must meet access standards

Quality and care coordination All beneficiaries should be in coordinated care with a medical home State plan option Inclusive participation Streamline rules Medicaid Advantage States share savings

…Quality and coordination Establish National Health Care Innovation Program Disclose payments to providers Measure quality Purchase quality outcomes, not just services

Medicaid Advantage States would have the option to create a new program for dual eligibles Federal funds for Medicare and Medicaid share would flow to states to develop an integrated care management program States or the plans they select would provide care on the Medicare Advantage model

Payment for Dual Eligibles: Current FFS Policy Go to Hospital or Nursing Home Stay at home. Go to Physician No Coordination of Care Payment from: Medicare Part A Medicaid Medicare Part B State $ Federal Match

Payment for Dual Eligibles: Seeking a Better Way Stay at Home Go to Hospital or Nursing Home $ Go to Physician $ State or Private Health Plan Provides Coordinated Care And Payment $ $ $ $ Medicare Part A Medicaid Medicare Part B State $ Federal Match

What’s next? Bringing better coordination to the patchwork design of Medicaid Using DRA tools to tailor programs to state needs Creating new momentum for Congress to give states more flexibility

Contact: Grace-Marie Turner Galen Institute www.galen.org (703) 299-8900 gracemarie@galen.org