Medicaid and CHIP: On the Road to Reform Vikki Wachino Director Children and Adults Health Programs Group Center for Medicaid, CHIP and Survey & Certification Centers for Medicare & Medicaid Services Alliance for Health Reform April 4, 2011

 CMS aims to be a major force and a trustworthy partner for the improvement of health and health care for all Americans  CMCS carries this mission forward with a particular emphasis on making Medicaid and CHIP the best programs they can be  Beneficiaries are our focus  Partnerships are critical to success Our Mission

 Uninsurance rates for children have steadily dropped due to Medicaid/CHIP  Coverage levels holding steady even in economic downturn  Disparities are narrowing Percentage of Children Without Health Insurance, By Poverty Level, Children below 200% of poverty Children above 200% of poverty 23% 16% 12% 6% 5% Lessons from Children’s Coverage Efforts: Success is Possible

The Secretary’s Challenge: Enroll the 5 million uninsured children who are currently eligible for Medicaid or CHIP over the next five years

Source: Congressional Budget Office, March 2010 Sources of Coverage by 2019 for Individuals Under 65 25m 23m 24m 51m 159m

 Not a safety net but a full partner in assuring coverage, quality and cost containment  Simplified and coordinated rules and process (eligible = enrolled; no churning)  A system of coverage and care New Paradigm Exchange Employer Coverage Medicaid/ CHIP Medicaid/ CHIP

2014 Health Insurance Subsidies Medicaid/CHIP Children 0 133% FPL 241% FPL 400% FPL Exchange Subsidies Adults Children Medicaid Adults Varies by State

Seamless Coordination and No Wrong Door  Exchange determines eligibility for Medicaid/CHIP/premium tax credit; other avenues open as well.  IT Guidance: “…Seamless coordination between the Medicaid and CHIP programs and the Exchanges and between the Exchanges and plans, employers, and navigators.” “First-class customer experience” “The same customer experience to all individuals seeking coverage, regardless of source or amount of subsidy for which they may qualify or whether they enter the process through the Exchange, Medicaid, or CHIP” “Real time” enrollment “Collaborative IT Development Approach” 8

 Accountable Care Organizations  Medical and health homes-90% match  Bundled payments to integrate care  Global payment demonstrations  Primary care provider increase (2013)  No payment for HACs  Innovations Center  Dual eligible office Quality, Access and Costs: New Tools

 Focus on Medicaid Cost Drivers  Existing Authority & New Initiatives Benefits & Cost-Sharing Integrated Care for High-Cost Beneficiaries; improving care transitions; reducing unnecessary hospitalizations Purchasing Drugs More Efficiently Assuring Program Integrity  Working individually with States (“MSTAT”) What CMS is Doing to Help States Reduce Costs Now

Concentration of Medicaid Spending 5% 25% 50% 54% 5% 1% Source: Medicaid Statistical Information System Claims Data for FY 2008 Percent of Total Medicaid Spending Percentile of Medicaid Population (ranked by spending) 49% 20% Children Total Population

 Reorganize and refinance the way care is delivered  Integrate primary and specialty care through medical homes  St. Joseph’s Hospital of Tampa reduced emergency room visits by more than 33% and hospital stays by 20%  Arkansas Children’s Hospital model is projected to annual child costs by more than 30% and reduce hospital admissions by 40% Focus on Children with Chronic Conditions

Achieving a High Performing Medicaid Program  Simplified, accurate, customer-friendly, data driven eligibility/renewal processes that are fully coordinated with the Exchange  Access to person-centered, high quality, integrated care with options for continuity of coverage with plans on the Exchange  Continuing improvements in quality and cost – throughout our health care system-- based on consumer experience, other stakeholder input, data, and collaboration.