Medicare & Medicaid News for Senior Citizens
Medicare & Medicaid News
Medicaid moving forward say Administration officials
CMS Blog: CMS updates how Medicaid works for most beneficiaries who get coverage through managed care plans
By Andy Slavitt, CMS Acting Administrator and Vikki Wachino, CMS Deputy Administrator and Director for the Center for Medicaid and CHIP Services
April 26, 2016 - If you haven’t been paying close attention over the last several years, you may have missed some of the major changes that have taken place in the Medicaid program.
You may know that some 72 million Americans rely on Medicaid as their source of health insurance coverage this year – 14 million more than in October 2013 thanks largely to the Affordable Care Act’s coverage expansion. For millions of children who need checkups or follow up care, pregnant women who want their babies to get a healthy start in life, adults who need health coverage when they unexpectedly lose a job, or people with disabilities who want to live independently in their communities, Medicaid has been there over the last 50 years to provide comprehensive health coverage to millions low-income American families.
But a lot has happened to health insurance coverage through Medicaid over the past several years as millions more people have gained coverage because of the Affordable Care Act: The federal government and the states have sought to strengthen the program’s focus on the consumer, the delivery of high quality care, and providing greater access points, and on developing a modern set of rules.
Today, we’re taking a next step in that work today by finalizing a long-anticipated rule that updates how Medicaid works for the nearly two-thirds of beneficiaries who get coverage through private managed care plans.
These improvements modernize the way these managed care health plans operate so that Medicaid and CHIP continue to provide cost-effective, high quality care to consumers. The rule strengthens states’ efforts to support delivery system reform and authorizes the first-ever Medicaid and CHIP quality rating system so that states can publicly report plan quality information, and people can use that information to select plans.
It also deploys 21st century tools to improve beneficiary communications, like electronic notices to beneficiaries and creating online provider directories. It better aligns key rules and practices with those of Marketplace and Medicare Advantage, including the addition of reporting medical loss ratio to Medicaid to ensure managed care plans focus on delivering care, not profits. And the rule also helps strengthen and improve the delivery of health care to low-income children served by the Children’s Health Insurance Program (CHIP).
But before you look at a summary of these rules, it’s worth catching you up on other major developments in Medicaid that affect every aspect of the consumer’s experience–from enrolling, to accessing high quality care, to the availability of home and community-based services.
A modern enrollment experience. Applying and enrolling in Medicaid coverage is now easier than it
once was and similar to the processes for applying for other
health insurance programs.
Access to high quality
physicians and other care providers. Access to quality health
servicesis always a central focus of
CMS, which was
strengthened through new policies recently that seek to
ensure access to care.
Quality care to strengthen
health outcomes. Medicaid is also
transforming the delivery of care. States
are making gains in using population based payments,
episodes of care, and quality-based payments.
A platform for innovation. Medicaid innovates more quickly when states have the tools to
respond to the needs of their residents. To help support these
delivery system reforms through improvements to the coordination
of patient care, states, with the support of CMS, are working to
update legacy IT systems to ones that leverage proven IT
Most importantly, Medicaid is there when you need it, for working class families, working Americans, people falling on temporary hard times, or living with a disability.
Take Todd, a full time student with two part time jobs in Utah who was recently profiled by the Kaiser Family Foundation. He and his wife, Erin, were uninsured but had a new baby. They learned that Erin and their baby Jane were eligible for Medicaid.
“When we found out that my wife and Jane would be covered, it definitely felt like a burden lifted a weight off our shoulders,” Todd said. “We don’t make enough to really take care of ourselves the way we would like to.”
It’s because of people like Todd and Erin and people like you that we have invested so heavily and thoughtfully in Medicaid and put forward the rules we have today, which will also support physicians and hospitals and states in improving service, quality and health for millions of Americans.