1. The Medicaid Commission Health Reform Initiatives presented by Grace-Marie Turner Galen Institute June 13, 2007 MC

2. 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

3. 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:

4. 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.

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

6. 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 MC

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

8. 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

9. 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

10. 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

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

12. 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

13. 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

14. 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

15. 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

16. Contact:
Grace-Marie Turner
Galen Institute
(703)