CMS Administrator Seema Verma and HHS Secretary Tom Price, MD, are sending a message — they are ready to reform Medicaid.
Just hours after Ms. Verma was sworn into office Tuesday, the CMS and HHS chiefs sent a letter to state governors declaring a commitment to improved collaboration on Medicaid programs and calling for Medicaid waivers. In addition to making the waiver process more transparent and efficient, the agencies plan to "fast-track" approval of waivers and waiver extensions.
Medicaid expansion under the ACA to nondisabled adults without children "was a clear departure from the core, historical mission of the program," by providing increased funds for this population, rather than the most vulnerable, Ms. Verma and Dr. Price wrote. "[T]he ACA provided states with an incentive to deprioritize the most vulnerable populations. The enhanced rate also puts upward pressure on both state and federal spending," they wrote.
To better allot funds, the letter urges governors to focus on several key areas of improvement in their Medicaid programs. Some of those areas include:
1. Adding employment requirements. Ms. Verma and Dr. Price made a commitment to approve state Medicaid waivers that require beneficiaries to have jobs or be in job training to qualify for benefits. The Obama administration denied waivers that included such provisions, according to The Washington Post.
2. Aligning the program more closely with commercial insurance. The letter suggests states reform Medicaid to better prepare beneficiaries for private insurance in the future through several reforms like adding monthly premium payments and emergency room copayments to plans. This structure also aligns with the plan Ms. Verma helped design in Indiana.
3. Providing better substance abuse care. Ms. Verma and Dr. Price committed to building on efforts to enhance tools to address the opioid epidemic. Recent efforts include regulatory changes allowing states to make managed care capitation payments for patients who stay 15 days or less in Institutions for Mental Disease, according to the letter.
"We intend for this to be the beginning of a discussion on how we can revamp the federal and state Medicaid partnership to effectively and efficiently improve health outcomes. We look forward to partnering with you in the years ahead to deliver on our shared goals of providing high quality, sustainable, health care to those that need it most," the letter concludes.
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