The Centers for Medicaid and Medicare Services is developing a federal minimum standard for healthcare access and principles for Medicaid waivers and is working with states on improving eligibility redeterminations, acccording to senior agency officials.
CMS Administrator Chiquita Brooks-LaSure and Center for Medicaid and Children's Health Insurance Program Services Director Daniel Tsai wrote a blog post for Health Affairs that categorizes the agency's agenda for these programs in three areas: expanding coverage and access, improving equity, and encouraging innovation.
Medicaid enrollment has ballooned during the COVID-19 pandemic, due in part to a requirement that states maintain their rolls in order to receive additional federal funds during the public health emergency. Medicaid covered more than 80 million people as of May, according to the most recent CMS data.
CMS can and should do more to make sure beneficiaries can actually access healthcare when needed, Brooks-LaSure and Tsai wrote. The agency will explore establishing a uniform minimum access standard for Medicaid and CHIP beneficiaries, and will work with states to come up with a strategy, the blog post says.
Coverage doesn't necessarily equate to access to providers and medical care, and CMS needs change this, Brooks-LaSure said at a National Association of Medicaid Directors conference Tuesday.
Download Modern Healthcare’s app to stay informed when industry news breaks.
CMS is developing a clear set of principles for 1115 waivers, which allow states to alter their Medicaid programs, that advance health equity and financial stewardship, the officials wrote in Health Affairs. Waivers should seek to expand coverage, promote value-based care and improve access to home care, mental healthcare and substance use disorder treatment, they wrote.
CMS also is looking ahead to the resumption of eligibility redeterminiations whenever the public health emergency is lifted. The agency's Center for Consumer Information and Insurance Oversight is working with state officials to get them ready to carry out the redeterminations and to guide ineligible people toward other forms of coverage. CMS already has provided guidance informing states that they have a year from the end of the public health emergency to complete redeterminations.
"As we head towards the end—at some point—of the pandemic, we are very, very focused on making sure we're working with states on all the operational details of resuming Medicaid/CHIP eligibility renewals and ensuring that everyone who is eligible for Medicaid continues coverage," Tsai said at the Medicaid directors conference. "That will and continues to be one of our top priorities."
Another key aim is closing the so-called Medicaid coverage gap. An estimated 4 million low-income people in states that haven't expanded Medicaid under the Affordable Care Act lack access to Medicaid benefits or to subsidized policies from a health insurance exchange. President Joe Biden and Democratic congressional leaders are trying to advance a domestic policy bill that would provide exchange subsidies to people in the Medicaid gap.
The CMS leaders also identified improving access to home- and community-based services as a goal, and highlights funding states can access from the American Rescue Plan Act. Democrats seek to add $150 billion for this initiative through the same legislation.