Tavenner: (Laughs and points to her desk) You see those notebooks and papers over there? It's like, “How much can you absorb in five days?” It's a little different for me. I don't know the history of every person who's ever been confirmed, but it's kind of hard for me to say I'm new to the job because I'm going on my fourth year. So that's actually a big advantage because, obviously, I know a lot of the policy; I've signed off on a lot of the policy, and that's helpful. Obviously, there is more detail than I need to learn. CMS is a huge agency. It's complicated, so there are lots of questions that can come up, but I'm actually looking forward to it.
Zigmond: Beyond the political opposition, what is the biggest technical or logistical challenge to expanding state Medicaid programs next year?
Tavenner: Each state has its own IT platform that they're working on, so those have to be updated. And so we've been able to give them a lot of the tools and some of our proposed rules—including rules that we released as recently as last week—help give them guidelines in that area. We're doing a lot of technical assistance on a state-by-state basis to meet a state wherever they are. Some states really are striving, particularly some of the state-based marketplaces are really striving to be totally automated, so that's fine. Some of them are going to need a little more time, and we get that, so we're just trying to meet them where they are and give them the information they need.
I think that the budget issue around Medicaid expansion—at least around the first three years—is the federal government's responsibility. But for many of them, they want to understand how this works. You've followed some of the Arkansas material about how can we use the exchanges, can we have premium assistance, so we've tried to clarify that (See story, p. 12). The secretary spends a lot of time meeting with governors. We spend a lot of time meeting with secretaries of health. Our Medicaid staff works with Medicaid teams inside each state, saying: “What are the issues? What are the political objections, and how can we help you with those? And what are the technical objections and how can we help you with those?”
Zigmond: Are you worried that you won't be ready by Oct. 1 for the open enrollment for the health insurance exchanges?
Tavenner: No. We will be ready by Oct. 1. There'll still be lots of outreach and education to go on after Oct. 1, and we have a six-month enrollment period.