Congress should make primary care a top priority for the Medicaid program, the nonpartisan Bipartisan Policy Center said in a report Monday.
The group called on Congress to support a comprehensive framework to improve primary care by directing HHS to help states share best practices and innovations and measure and report "spending on primary care as a percentage of total healthcare spending." In addition, Congress should fully fund the Primary Care Extension Program.
Lawmakers should also boost access to insurance coverage by allowing states to expand Medicaid. States could follow traditional expansion to adults making up to 138% of the federal poverty level and receive 100% matching federal funds, eventually phasing down to 90%. Or they could expand Medicaid coverage to people making 100% of the federal poverty level and receive 88% matching federal funds if they do it within two years.
Likewise, Congress should allow states to automatically enroll eligible people in Medicaid, Children's Health Insurance Program or marketplace subsidies. States would only be permitted to enroll people in marketplace subsidies if the subsidies fully covered an individual's premium costs. BPC also recommended creating a new option for states to sign up eligible adults in 12 months of continuous Medicaid coverage, preventing coverage lapses and reducing reporting for enrollees.
Congress should also mandate fee-for-service Medicaid to cover preventative care services with no cost-sharing to make sure beneficiaries aren't discouraged from seeking high-value care.
"Access to primary care can help individuals live longer and help avoid or delay the onset of costly chronic conditions such as diabetes, heart disease and cancer," according to the report. "Access to primary care can also help reduce more expensive care, including hospitalizations and emergency department visits."
Hemi Tewarson, director of the National Governors Association's health division, said during a panel discussion that she's concerned states won't have enough resources to invest in primary care because of the downward pressure on state budgets caused by the COVID-19 pandemic, which could have long-term ramifications on the U.S. healthcare system.
The Bipartisan Policy Center also recommended boosting Medicaid's matching federal funds to 100% for primary care services for five years if states pay for them at the Medicare rate. According to the report, higher reimbursements for primary care services would ensure enough primary care providers to deliver care to Medicaid enrollees.
Likewise, HHS should delay any changes to network adequacy requirements for Medicaid managed care organizations until CMS develops data-driven access standards. According to the report, Congress should order HHS to regulate network adequacy for Medicaid MCOs "based on the new data-driven standard."
The Bipartisan Policy Center recommended several other actions to increase the primary care workforce, including increased federal coordination of workforce development efforts and more visa waivers for foreign medical graduates.
The report also includes a wide range of recommendations to address racial, ethnic and economic disparities in Medicaid. They include blocking implementation of the June rule eliminating nondiscrimination regulations, requiring HHS to issue guidance to states about how to pay community health workers to address chronic conditions and empowering HHS to approve Medicaid coverage of non-medical services to address the social determinants of health.
Congress created the Primary Care Extension Program under the Affordable Care Act to improve primary care quality, but it never funded the program. According to the legislation, it was supposed to transform primary care by educating "providers about preventive medicine, health promotion, chronic disease management, mental and behavioral health services, and evidence-based and evidence-informed therapies and techniques."
Correction: CMS will develop data-driven access standards. An earlier version of this story cited the wrong organization, based on incorrect information in the Bipartisan Policy Center report.