In other upcoming developments, the CMS plans to release new rules on Medicaid managed care in the first quarter, updating rules published in 2001. Currently, 37 states and the District of Columbia contract with Medicaid plans.
Major questions also remain about the fate of the Obama administration's initiative, mandated by the ACA, to better coordinate benefits and care for Americans who are dually eligible for Medicare and Medicaid and account for a disproportionate share of those programs' costs.
To date, California, Illinois, Massachusetts, Ohio and Virginia have launched dual-eligible demonstrations, which have experienced lower-than-expected enrollment and plan and provider participation. Demonstrations also are slated to begin this year in Michigan, New York, South Carolina, Texas and Washington state.
Congress will face bipartisan pressure to extend funding for CHIP, which expires Sept. 30. About 10.2 million children are now enrolled in the program. Of those, as many as 2 million may suffer loss of coverage or healthcare access if the program ends, researchers say.
As far as Medicaid expansion, advocates were worried at the start of the year when the CMS gave Arkansas permission to impose modest cost-sharing on individuals under the federal poverty level. The maximum monthly amount beneficiaries below the poverty level will pay is $5. It was previously thought the administration would not allow states to impose any costs on people under 100% of poverty.
“I understand the position of CMS is that they want to get states to expand, but we're seeing an erosion of the basic features of Medicaid that make it work for low-income people,” said David Machledt, a policy analyst at the National Health Law Program.