Recommendations from the Medicaid Commission State Coverage Initiatives National Meeting Ann Volpel January 25, 2007

Presentation Roadmap Background on Medicaid Commission Discussion of recommendations that may impact state coverage initiatives Other things to keep your eyes on

Medicaid Commission Created in 2005 with two-fold charge Identify options to achieve $10 billion in scorable savings over 5 years Address the long-term sustainability of the Medicaid program Reports are available at http://aspe.hhs.gov/medicaid/

Five Areas of Recommendations Long-term Care Benefit Design Eligibility Health Information Technology Quality and Care Coordination

These Are Only Recommendations Many recommendations require Congressional action and/or changes in federal regulation Supportive of state flexibility and private sector investment

Benefit Design Recommendations

Allow states to customize benefit packages Medicaid is a “full coverage” program Private health insurers customize benefit packages to meet population needs States should have the same flexibility Including the ability to separate eligibility for acute/preventive care benefits from eligibility for long-term care benefits

Allow states to customize benefit packages Should be available through a state plan amendment Suggests that CMS could require wrap-around EPSDT coverage for children Silent on population restrictions and the need to match “benchmark” coverage (current requirements) Recommendation includes language about the need for an adequate provider network to deliver covered benefits

Premium Assistance Programs Encourages states: to capitalize on existing private sector investments in health insurance coverage with premium assistance programs and to create opportunities for working uninsured to purchase a basic benefit package Option should be available without a waiver, provided it meets cost-neutrality requirements

Create an Abbreviated Waiver Process for Replicating Programs States should have the ability to replicate demonstrations from other states: Using an abbreviated waiver process If the demonstration has operated successfully for at least 2 years Such waiver applications should be automatically approved 90 days after date of application, if replication criteria are met

Reviewed by CRS; Created by Senate Republican Conference

Other areas to keep your eyes on… Federal government should provide new options for the uninsured to obtain private health insurance through refundable tax credits or other targeted subsidies Study of a “scaled match” funding formula for Medicaid to encourage states to target expansions to populations at lower poverty levels

Contact Information Ann Volpel Center for Health Program Development and Management University of Maryland, Baltimore County (UMBC) (410) 455-6518 avolpel@chpdm.umbc.edu