cost, value, and reimbursement issues: the medicaid perspective kathleen nolan national assoc. of...

Cost, Value, and Reimbursement Issues: The Medicaid Perspective Kathleen Nolan National Assoc. of Medicaid Directors March 7, 2013

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Cost, Value, and Reimbursement Issues: The Medicaid Perspective

Kathleen NolanNational Assoc. of Medicaid Directors

March 7, 2013

Medicaid Interest High

• Medicaid is a major payer for births in this country– Poor birth outcomes is a heavy cost burden

• Delivery system and payment reform a focus area for agencies– A number of multi-payer initiatives underway

• Many moms in managed care– May offer more “mainstream” birth options.

Page 3: Cost, Value, and Reimbursement Issues: The Medicaid Perspective Kathleen Nolan National Assoc. of Medicaid Directors March 7, 2013

States vary widely

• Medicaid• Health facilities oversight and regulation• Professional regulation• Community norms

This variation will make establishing a national picture/baseline difficult.

Page 4: Cost, Value, and Reimbursement Issues: The Medicaid Perspective Kathleen Nolan National Assoc. of Medicaid Directors March 7, 2013

Future of Pregnancy Coverage

• Expansion or not by state• Eligibility levels for pregnant women vary by

state and could change• Churn among coverage programs an open

question

Page 5: Cost, Value, and Reimbursement Issues: The Medicaid Perspective Kathleen Nolan National Assoc. of Medicaid Directors March 7, 2013

Encouraging Alternative Settings

• Data collection challenges• A national standard will be difficult to

establish• Shifting landscape in Medicaid for coming (5?)

years

• But…interest is high, so sharing of best practices will be important.

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