medicaid moving forward through partnership · medicaid moving forward 4 policy development and...
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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
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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
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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…