Medicaid Moving Forward Through Partnership

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Cindy Mann, DirectorCenter for Medicaid, CHIP Services

May 30, 2012

Medicaid Moving Forward

Moving 

from a 

safety net 

program 

To a full 

partner in 

the health 

care system

Ensuring 

better care, 

better 

health, 

lower costs

Source:  Congressional Budget Office, March 2010Source:  Congressional Budget Office, March 2010Source:  Congressional Budget Office, March 2010

Sources of Coverage by 2019 for Individuals Under 65

25m

23m24m 51m

159m

Medicaid Moving Forward

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Policy Development and Operational Guidance

Policy Development and Operational Guidance

Delivery System and Payment Reform

Systems Modernization

Coordination with Other Coverage

Analysis,Measurement, Improvement

Outreach and EnrollmentOutreach and EnrollmentOutreach and Enrollment

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Policy Development

Fundamental revamping of eligibility, enrollment, renewalEligible = EnrolledCoordination with Exchange

Policy 

Guidance

Income Eligibility for Insurance Affordability Programs

6

Medicaid Adults

Qualified Health Planswithout Financial Assistance

138%FPL

250%FPL

400%FPL

Medicaid/CHIP Children

CHIP/Medicaid for Children

FPL Varies by State

Cost-sharing reductions between 138% - 250% FPL

Qualified Health Plan withPremium Tax Credits‐138%‐400% FPL

Seamless, Streamlined Eligibility and Enrollment

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Promoting Continuity of Coverage and Care

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Continuous Health Coverage

9

Estimated Distribution of Costs for Medicaid  Coverage Changes: 2014‐2019 

(in billions)

Total $464.7 billion

Source:  Congressional Budget Office and Medicaid Coverage and 

Spending in Health Reform, John Holahan

and Irene 

Headen/Kaiser Commission, May 26, 2010

Who Pays?

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Modernizing Systems

90% federal funding for IT Systems development (eligibility until December 31, 2015) and 75% for maintenance (ongoing)46 states have approved or pending APDs

Systems 

Development

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Modernizing the Way We Do Business

Federal, State and Industry Activities

Tools and Support for States Expedited APDs/ 7 Standards and Conditions

SPA process redesign/ Performance Metrics

Learning Collaboratives, workgroups, pilots

Waiver transparency

Medicaid.gov

New Ways

To Do

Business

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Changing the Way Care is Delivered

Delivery System and Payment ReformMedicaid/Exchange AlignmentMedicaid/Medicare AlignmentHealth Information TechnologyQuality Measurement

Care Delivery

Improvement

Concentration of Medicaid Spending

5%

25%

50%54%

5%1%

Source: Medicaid Statistical Information System Claims Data  for

FY 2008  

Percent of Total Medicaid SpendingPercentile of Medicaid Population(ranked by spending)

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Assuring Results

Information Systems Measuring and Improving

Quality/Access/CostsProgram Administration

Analysis

Evaluation

Improvement

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Integrated View of Program 

Performance

Gathering Actionable Information

States Moving Forward

27 States have approved or pending health home SPAs or planning grants46 States have approved or pending APDs for E and E systemsStates as diverse as California, Texas and Massachusetts have delivery system transformation waiversNorth Carolina has Community Care Networks and Oregon is establishing Community Care OrganizationsUtah has adopted electronic noticesLouisiana has streamlined its renewal process to substantially reduce use of paper renewal formsTennessee is exploring Medicaid/Exchange Bridge PlansArkansas is developing episode‐based paymentsCamden New Jersey is hot spotting high cost cases through a community‐accountable care delivery systemConnecticut, DC, and Minnesota have adopted the early coverage option for childless adults; Six States have new waivers to do soMassachusetts has an approved asthma prevention demonstration39 states have paid than $1.2B in Medicaid HIT incentive payment to providers in their StatesETC…