IAP was developed in large part based on input from the National Governors Association's Health Care Sustainability Task Force, composed of a bipartisan group of 10 governors, including some from states that expanded Medicaid under the Patient Protection and Affordable Care Act—such as Gov. Mike Beebe (D-Ark.) and Gov. Jerry Brown (D-Calif.)—as well as from states that have not—such as Gov. Bill Haslam (R-Tenn.) and Gov. Robert Bentley (R-Ala.),
The aim of the task force was to come up with ways to lower the regulatory barriers for states to continue Medicaid experiments that were showing signs of success or adopt models bearing fruit in other places, said Dan Crippen, the National Governors Association's executive director.
The CMS has not provided details on what kinds of projects it will support. In the coming weeks, the agency plans to hold webinars and other interactive sessions to gather input from states, consumers and experts on the initial plans for and structure of the initiative.
In a July 14 letter to states (PDF), the CMS outlined several current endeavors that officials identified as steps in the right direction. For instance, in 2008, North Carolina implemented a transitional-care program that provided comprehensive medication management and face-to-face self-management education for beneficiaries with multiple chronic conditions who were recently hospitalized. The patients in the program have had 20% fewer readmissions than similar patients.
Nationwide, while Medicaid spending overall has grown as more people have gained coverage, initiatives such as North Carolina's have helped per enrollee spending decline by 1.2%—from $6,768 to $6,641—in 2012, according to the CMS.
“As Medicaid grows as a result of the Affordable Care Act, it is now more important than ever that there be continued innovation in every level of Medicaid,” said Dr. Jay Himmelstein, professor of Family Medicine and Community Health and Quantitative Health Sciences at University of Massachusetts Medical School.
The new CMS initiative has the potential to help state make meaningful changes to their Medicaid programs even if they don't have the resources to do it on their own, said Yevgeniy Feyman, a fellow at the Manhattan Institute, a conservative think tank. The IAP can become a centralized source for data analytics and key technical infrastructure for these states, Feyman said.
Some observers, though, are skeptical.
The central idea of the new program—that it's possible to develop a successful initiative in one state and replicate it in another—is flawed, said Joseph Antos, a healthcare economist with the conservative-leaning American Enterprise Institute. “If something works somewhere, there are a lot of reasons it might not work in other places, including different leadership and the capacity of state Medicaid staff,” Antos said.
Robert Kaestner, a research associate for the conservative-leaning National Bureau of Economic Research, said the CMS is setting up the project for failure by choosing which efforts to back. “It is a way to dole out money to states so that feds can say they are working with states to innovate,” Kaestner said. “It will have virtually no effect on Medicaid program in terms of cost and quality.”