States would be allowed to open their Medicaid programs to a broader base of health insurance plans, and providers would be allowed to collect payment upfront from all but the poorest Medicaid recipients before providing care under two new rules proposed by the CMS.
Under another provision, hospitals would be allowed to charge Medicaid recipients if they receive care through the emergency department for problems that are otherwise not deemed critical or could have been treated elsewhere.
The provisions in the proposed rules are part of broader Medicaid reforms that were first set out in the Deficit Reduction Act of 2005 and were aimed at giving states the flexibility to tailor their own programs in cost-effective ways. According to a CMS news release, the proposed rules are expected to be published in the Feb. 22 Federal Register and will have a 30-day public comment period.
Under the proposals, states could pattern their Medicaid programs more like private insurance plans through alternative benefit packages called benchmark plans.
These new rules recognize that states are in the best position to design plans that provide Medicaid beneficiaries better healthcare for the same or even lower cost, HHS Secretary Mike Leavitt said the news release. The proposed rules will result in patients having more choices and greater control over their healthcare decisions.
But some members of Congress balked at the proposals. The real impact of these policies will be fewer services and higher prices for millions of low-income families who rely on Medicaid for their healthcare needs, Rep. Frank Pallone (D-N.J.), chairman of the Energy and Commerce Subcommittee on Health, said in a statement. At a time when our economy is suffering and more Americans may become eligible for Medicaid, we should be looking for ways to bolster the program, not weaken it by scaling back benefits and shifting costs. -- by Matthew DoBias