States would have greater control over how to protect the rights of Medicaid HMO enrollees under a proposal released last week by the Centers for Medicare and Medicaid Services.
The proposal would revise a set of final Medicaid regulations issued Jan. 19, the day before President Clinton left office. Originally scheduled to take effect April 19, the regulations were put on hold as part of a regulatory review ordered by President Bush.
With the mandatory public-comment process that must follow the new proposal, the nation's 19 million Medicaid managed-care enrollees may have to wait until next year for the federal government to guarantee those protections.
The new proposal, scheduled to be published in the Aug. 20 Federal Register, will be open for comments for 60 days.
The Jan. 19 regulations guarantee Medicaid beneficiaries certain rights, such as an appeals process, emergency room coverage, direct access to obstetricians and gynecologists, second opinions, and unrestricted communications between doctors and patients. The same guarantees are part of a managed-care reform bill for the private market being debated by Congress.
A CMS official said the agency doesn't intend to withdraw any of the protections in the Clinton administration regulations but instead will offer states more flexibility about how they implement the regulations.
It's in keeping with another White House plan issued earlier this month that will allow states the chance to trim Medicaid benefits for some populations if they use the savings to expand coverage to more people (Aug. 13, p. 18).
Consumer advocacy group Families USA, however, criticized the CMS proposal.
"States have acted aggressively to move Medicaid beneficiaries into managed care, yet the consumer protections promised continue to be delayed by the Bush administration," said Joan Alker, the group's associate director of government affairs.