Technology to help CMS revamp Medicaid

The Medicaid expansion was supposed to be the least controversial part of the health reform lawsuit. But since the Supreme Court essentially made broadening its eligibility voluntary for states, not a day goes by without news reports guessing how Medicaid will fare in the future. 

“But it’s all to the good,” said Cindy Mann, director of the Center for Medicaid and Children’s Health Insurance Program (CHIP) Services. 

“The importance of states’ decisions going forward about whether to take up the Affordable Care Act Medicaid expansion can’t be overstated,” she said. States are crunching the numbers, consulting with stakeholders and, in many instances state legislatures will be actively engaged.

[See also: Interoperability failure causes headaches for Maine Medicaid.]

“There is no particular time deadline for a state to declare its intentions, unlike the need for a state to determine by later this fall whether or not they will build a state-based health insurance exchange or doing a partnership model or a federally facilitated exchange,” she said at a July 30 conference sponsored by the Bipartisan Policy Center.

The Centers for Medicare and Medicaid Services is still sorting through the implications of the June Supreme Court decision. For states that decide to move forward with expansion, CMS will pay 100 percent in matching funds for the first three years through 2016 and notch down to 90 percent in subsequent years.

“We expect states will be taking the next several months to make their decisions. But we believe that when states look at the factors and consider the impact on coverage relative to their state, financial support that the federal government will provide, the impact on uncompensated care, the impact on hospitals, health plans, providers and employers, one way or the other, they will decide that it is in the state’s interest to move ahead,” Mann said.

With or without the Medicaid expansion, CMS is working with every state on implementation of the Patient Protection and Affordable Care Act by 2014.

States are modernizing eligibility systems for Medicaid, simplifying the way they determine eligibility and advancing toward a data-driven system of verifying eligibility and for accommodating online applications. States also have to make sure that Medicaid and CHIP are well coordinated with the insurance exchange and have established interfaces so consumers can experience a seamless system of coverage.

[See also: Public-private partnership to root out healthcare fraud.]

CMS has recently established operational technical assistance teams for each state that are made up of subject matter experts who know the financing rules, benefits, eligibility, outreach and enrollment for states to call on when they have questions or seek solutions.