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

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

3. 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

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

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

6. Benefit Design Recommendations

7. 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

8. 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

9. 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

10. 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

11. Reviewed by CRS; Created by Senate Republican Conference

12. 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

13. Contact Information
Ann Volpel
Center for Health Program Development and Management
University of Maryland, Baltimore County (UMBC)
(410)