Cindy Mann will have a lot on her plate when she takes the helm of the CMS Center for Medicaid and State Operations as its director, scheduled for June 8.
One has state-federal issues ...
Mann to deal with entitlement vs. flexibility: Smith
Mann, who most recently served as a research professor and executive director of the Center for Children and Families at Georgetown Universitys Health Policy Institute, is no novice to healthcare policy. She worked at HHS once before, when the CMS was called the Health Care Financing Administration, and played a key role in implementing Medicaid and the State Childrens Health Insurance Program.
Flash forward nearly 10 years, and Mann faces a very different environment in Washington. In the urgency to approve a healthcare reform bill, lawmakers are eyeing the $300 billion Medicaid program as a way to expand coverage to more low-income populationsthose earning up to 400% of the federal poverty level, or $88,200 for a family of four based on 2009 guidelines.
Couple this with conflicting state-federal interests and its clear that Mann will have to answer to a lot of stakeholders from across the country as this push to reshape Medicaid and the rest of the healthcare system evolves.
I am honored to have been asked to lead CMSO at this most exciting time, Mann said in an e-mail. With state economies in a downturn and families losing their jobs and their healthcare coverage, new options and funding for childrens coverage made available through the CHIP reauthorization law, movement forward in the area of home- and community-based services for people with disabilities, and the prospect of health reform, there is much to be done.
Mann will be facing fiscal pressures on every level of government, increasing enrollment in Medicaid driven by unemployment and the aging of the population, and provider gaps between payment levels and legitimate cost of careall in context with the most significant healthcare reform effort in history, said Dan Sisto, president of the Healthcare Association of New York State.
Some lawmakers on Capitol Hill seem fairly confident that Mann will serve as a strong leader in the Medicaid program as Congress and the Obama administration move ahead with healthcare reform. Sen. Jay Rockefeller (D-W.Va.) who is chairman of the Senate Finance Health Care Subcommittee, said in a written statement he believes Mann is the ideal person to have at the helm during the healthcare reform debate. Cindy Mann is a tireless advocate for children and families who brings a wealth of experience and knowledge to the table. She will take Medicaid and CHIP in a new and positive direction, which is exactly what our country needs, Rockefeller said.
Manns predecessor, however, believes shell have her work cut out for her on
several fronts. The biggest challenge Mann will face is the ongoing conflict in philosophy between left-leaning advocates who believe that government-run entitlement programs should be preserved at all costs, and the states that enjoy the flexibility to test new policies under Medicaid via the Social Security Acts Section 1115 program, said Dennis Smith, senior fellow in healthcare reform with the conservative think-tank Heritage Foundation, Washington.
What do you do, for example, with a state like Indiana? Smith asked. The Hoosier State allows individuals in the Medicaid program to build resources within an account for participating in healthy lifestyle behaviors, he said. The new administration, in pushing for national uniformity among state Medicaid programs, may not necessarily advocate for a program like Indianas, Smith said.
One of those state experiments, a two-county managed-care project in Florida, was
recently declared dead by a state legislator and likely will no longer be funded by the state, despite the fact Florida would lose $300 million in federal funding as a result (May 18, p. 17).
State Medicaid representatives seem optimistic that they can work productively with the new administration to get their needs met. I do hope we dont lose the principle that states are the laboratories of future program opportunities, said Alan Levine, secretary of the Louisiana Health and Hospitals Department. At the same time, we see big changes coming, and we want to be supportive of those changes. Our hope is that Cindy Mann will reach out to the states and have a good dialogue with us.
Smith predicts that state-federal tensions in grappling for Medicaid dollars will continue. In the Obama administrations push for greater accountability, states down the road may not be able to take advantage of things such as the upper payment limit, a mechanism that provides states with greater access to federal matching dollars without having to match those dollars themselves, Smith said.
The CMS issued a regulation during the Bush administration that tried to restrict states use of the upper payment limit, but after several hospital associations sued HHS over the matter, a federal judge in Washington slapped down the CMS regulation for procedural reasons in May 2008.
Hospitals in the meantime, are hoping that federal Medicaid takes their needs into consideration, in crafting changes to the cash-strapped program.
Public hospitals in Texas currently fund a significant portion of the states Medicaid program and indigent healthcare through intergovernmental transfers. As healthcare reform is debated, policymakers must consider the impact on how Medicaid disproportionate-share and upper-payment-limit programs are used to fund care for low-income patients, said Dan Stultz, president and chief executive officer of the Texas Hospital Association.
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