Feds aim to help states with Medicaid reform gaps

By Anthony Brino
08:12 AM

Medicaid is covering more Americans than ever, while challenging the state budgets like never before, in many places reaching a quarter of annual expenditures.

Now, the federal government is working to help states fill in the gaps of reform initiatives, as they try to make Medicaid more accessible and affordable.

With some 66 million Americans now insured through Medicaid, the Centers for Medicare & Medicaid Services is launching a new initiative called the Medicaid Innovation Accelerator Program to invest $100 million over five years for new “state-led payment and service delivery innovations to improve health, improve care and decrease costs for individuals enrolled,” wrote Cindy Mann, director of CMS’s Center for Medicaid & CHIP Services, in a blog post with Patrick Conway, MD, CMS chief medical officer.

The program will let states tap into federal investment for “capabilities in technical areas such as data analytics, service delivery and financial modeling, quality measurement and rapid cycle evaluation to move their Medicaid payment and service delivery models to the next level,” Mann and Conway wrote.

Funding those areas, especially technology, will help fill gaps states have as they experiment with or adopt new payment and delivery models in Medicaid. Fifteen states are using health home policies for Medicaid beneficiaries with multiple chronic conditions and 25 states are currently participating in the State Innovation Models initiative that’s testing multi-payer payment and delivery system transformation models.

Among states in the midst of designing new Medicaid payment models under the innovation program are California, Texas, Illinois, Pennsylvania and Michigan. Six states, including Maine, Massachusetts, Minnesota and Vermont, are sharing $250 million in funding to test designs of new models.

Thirteen states are also trying new payment and delivery for Medicaid-Medicare dual-eligibles, services that collectively represent about $300 billion annually and are often described as poorly coordinated across benefit types.

Mann and Conway said the new grant program and its aims to fill in gaps were developed with suggestions from a task force at the National Governors Association, as a way to try to make Medicaid policy more collaborative, and they point to a few early successes. After adopting new learning collaboratives for providers, Ohio’s Medicaid program has seen early elective deliveries decline by about 30 percent, while a chronic condition management initiative in North Carolina has come with a 20 percent decrease in readmissions.

In Colorado in the 2013 fiscal year, a Medicaid ACO program now covering about half the state’s beneficiaries saw a 15 percent reduction in hospital admissions and a 25 percent reduction in high-cost imaging, contributing $44 million in savings. Most of the savings went to providers as incentive bonuses, while $6 million was returned to state coffers. To keep up those results, state leaders are banking on the program’s analytics initiative, which reports quality performance to Medicaid officials and offers primary care practices and regional collaborative organizations a care management platform.

Nationwide, Mann and Conway said, Medicaid spending per enrollee is starting to decline — a slight bending of the cost curve — from $6,768 to $6,641 in 2012, even though overall costs are growing along with enrollment thanks to states expanding eligibility to new groups of citizens, including childless adults.

With 24 states not expanding Medicaid eligibility, uninsured populations will remain in large swaths of the country, including much of the South. Hospital advocates and civic groups are taking steps to try to get everyone who is eligible for Medicaid enrolled, especially kids.

The National League of Cities has awarded grants and technical assistance to eight cities — including Dallas, Hattiesburg, Jacksonville, Pittsburgh and Savannah — to help them develop comprehensive enrollment campaigns for children and families.

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