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The Voice of Thomas Johnson
This has shaped up to be an extremely active year for Medicaid. From fighting off proposals to cutting funding from the program, to the Trump Administration’s efforts to change Medicaid administratively as we know it, to active state legislatures and, in a couple of cases, citizen referendums, to changing their states approach to Medicaid, this is arguably the most active time since the fallout of the NFIB vs. Sebelius case, which decided the federal government could not mandate state participation in Medicaid expansion.
The Center for Connected Health Policy (CCHP) released its now biannual report on state telehealth policies and Medicaid. While many states are beginning to expand telehealth reimbursement, others continue to restrict and place limitations on telehealth-delivered services. Although each state’s laws, regulations, and Medicaid program policies differ significantly, certain trends are evident when examining the various policies. Live video Medicaid reimbursement, for example, continues to far exceed reimbursement for store and forward and remote patient monitoring (RPM).
On March 23, 2018, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that would provide for a reduction of administrative burden with states that have high rates of Medicaid managed care enrollment. In the past, states with high enrollment have raised concerns regarding administrative burden when they have to determine whether Medicaid payments in Fee-for-Service systems are sufficient to enlist providers to ensure beneficiary access to covered care and services consistent with the statute.
Many states are looking to add work requirements for their Medicaid recipients. The “fever” that has spread with various governors and state legislators has translated into 20 states in some form or another considering work requirements, either through the waiver process or through legislation. Some states are dealing with this question through their budget process, and some states are attempting to couple Medicaid expansion with work requirements.
In the January 11, 2018, letter published by the Centers for Medicare & Medicaid Services (CMS) giving the green light for states to pursue adding work requirements to their Section 1115 waiver programs, the Trump administration, through CMS, has looked to push the envelope as to how far they can modify the Medicaid program as we know it. Changes have not only included typical proposed structural changes, such as turning Medicaid into a block grant program, but new proposals are aimed at the very heart of what Medicaid means—and these proposed changes are being led by the states.
Many thought, with the failure of the U.S. Congress to repeal the Affordable Care Act (ACA) at the end of the 2017 fiscal year, the act was safe from another repeal effort under this Congress. While the names in the Senate may remain the same, the effective plan may have now changed. Former Centers for Medicare & Medicaid Services (CMS) Administrator Andy Slavitt has described this as “synthetic repeal.”
Reauthorization for the Children’s Health Insurance Program (CHIP) lurks behind Washington’s focus on the Affordable Care Act (ACA) repeal and replace efforts. But the battle may be as contentious, and the added factor of a September 30th deadline makes stakeholders worry.