Elon Musk’s Department of Government Efficiency, launched under President Donald Trump, is ramping up its efforts to crack down on federal healthcare spending. The department is zeroing in on what it sees as wasteful expenses at CMS, potentially leading to Medicaid cuts or changes such as work requirements, stricter eligibility, or funding caps. These shifts could create financial instability for health systems that rely heavily on Medicaid reimbursements or who operate managed care plans, particularly in states where Medicaid programs are already under financial strain.
At the same time, insurers are grappling with a mismatch between Medicaid funding and the actual cost of care, especially for high-needs beneficiaries, following the unwinding of COVID-19-era continuous coverage protections.
Becker’s sat down with Brendan Harris, president of UPMC for You and state programs, who leads the Pittsburgh-based health system’s Medicaid operations serving more than 880,000 enrollees.
Question: What’s top of mind for you right now in the Medicaid space?
Brendan Harris: It’s a scary time right now for a lot of us in Medicaid, especially after one of the hardest years Medicaid programs across the country have faced. The pandemic revealed cracks in the delivery of services, and the unwinding of the public health emergency exposed challenges on the payer side. We’ve gone through an existential crisis in Medicaid.
Coming out of the public health emergency, we’re seeing many foundational challenges with Medicaid programs nationwide. This has created a lot of complicating factors, and we face many unknowns about what’s next. Congress is having conversations about work requirements, potential decreases in the Federal Medical Assistance Percentage, and other proposals. We’re watching these developments closely. The resilience of anyone working in Medicaid is incredible, especially considering how much change we’ve seen in the past decade. There’s a lot of optimism, but many questions remain about what this will mean for the people we serve and for UPMC.
Q: How is UPMC preparing for any potential changes?
BH: We’ve been working through different scenarios, considering all potential changes. Reflecting on 2024, the impacts of the unwinding and its effects on our finances have us sitting with bated breath. At the end of the day, we’re serving real people, and we’re committed to making sure Medicaid remains a vital part of the safety net. UPMC is running hospitals in both rural and urban settings, alongside running our Medicaid program. It’s all interconnected, and we’re closely monitoring what’s coming next.
Pennsylvania has experimented with work requirements in past Medicaid expansions, so we’re preparing for what that might mean again. We’re also considering what a decrease in the FMAP could mean for service delivery. We’ve been working closely with regulators in Pennsylvania to ensure we’re all aligned as we approach any changes. With leadership changes at CMS and an unclear sense of what’s ahead, we’re left in a state of anticipation, preparing the best we can.
Q: What excites you most about the future of Medicaid?
BH: Medicaid is an incredible program. I think about UPMC’s journey and how we’ve evolved in serving the most vulnerable populations. That evolution continues, regardless of the challenges, and I’m hopeful about the future.
One area where I see hope is in Managed Long-Term Services and Supports, which supports seniors and people with physical disabilities. The lessons we’ve learned about meeting people where they are and delivering person-centered care are invaluable. Looking ahead, I’m optimistic about aligning Medicare and Medicaid to serve dual eligibles and meet the whole person’s needs. One hallmark of UPMC’s work is finding creative solutions, especially during tough times. It’s forced us to partner with organizations we may not have worked with before, all to find the best solutions for the people we serve. While we still need to stabilize, as we look to the future, I’m excited about the long-term potential. The foundation we’ve built across Medicaid programs positions us to be flexible, find innovative solutions, and define value beyond a fee-for-service system.
