If you haven’t been paying close attention over the last several years, you may have missed some of the major changes that have taken place in the Medicaid program
You may know that some 72 million Americans rely on Medicaid as their source of health insurance coverage this year – 14 million more than in October 2013 thanks largely to the Affordable Care Act’s coverage expansion. For millions of children who need checkups or follow up care, pregnant women who want their babies to get a healthy start in life, adults who need health coverage when they unexpectedly lose a job, or people with disabilities who want to live independently in their communities, Medicaid has been there over the last 50 years to provide comprehensive health coverage to millions low-income American families.
But a lot has happened to health insurance coverage through Medicaid over the past several years as millions more people have gained coverage because of the Affordable Care Act: The federal government and the states have sought to strengthen the program’s focus on the consumer, the delivery of high quality care, and providing greater access points, and on developing a modern set of rules.
Today, we’re taking a next step in that work today by finalizing a long-anticipated rule that updates how Medicaid works for the nearly two-thirds of beneficiaries who get coverage through private managed care plans. These improvements modernize the way these managed care health plans operate so that Medicaid and CHIP continue to provide cost-effective, high quality care to consumers. The rule strengthens states’ efforts to support delivery system reform and authorizes the first-ever Medicaid and CHIP quality rating system so that states can publicly report plan quality information, and people can use that information to select plans. It also deploys 21st century tools to improve beneficiary communications, like electronic notices to beneficiaries and creating online provider directories. It better aligns key rules and practices with those of Marketplace and Medicare Advantage, including the addition of reporting medical loss ratio to Medicaid to ensure managed care plans focus on delivering care, not profits. And the rule also helps strengthen and improve the delivery of health care to low-income children served by the Children’s Health Insurance Program (CHIP).
But before you look at a summary of these rules, it’s worth catching you up on other major developments in Medicaid that affect every aspect of the consumer’s experience–from enrolling, to accessing high quality care, to the availability of home and community-based services.
- A modern enrollment experience. Applying and enrolling in Medicaid coverage is now easier than it once was and similar to the processes for applying for other health insurance programs. Enrolling into Medicaid was once very complicated, involving lots of paperwork, long waits and in-person interviews. Now, most people apply on line, by phone, or at a location convenient for them. More convenient, one-stop enrollment is possible in part thanks to sophisticated technology pursuant to the Affordable Care Act that allows enrollee information to be verified electronically – and without paper documentation. In some states, as many as 50 percent of individuals now enroll through these automated processes.
- Access to high quality physicians and other care providers. Access to quality health services is always a central focus of CMS, which was strengthened through new policies recently that seek to ensure access to care. Today’s rules take additional steps that will more tightly align payment with better, more cost-effective care. And new rules create real accountability to ensure access to care is sufficient in key specialties. Thanks in part to the work that CMS and states have done to make sure people have access to health services, adults with Medicaid coverage are just as likely to obtain primary care services as those with private insurance, while experiencing less difficulty paying their medical bills than others. And, people with Medicaid coverage report very high satisfaction, even higher than those who get health insurance through their place of employment.
- Quality care to strengthen health outcomes. Medicaid is also transforming the delivery of care. States are making gains in using population based payments, episodes of care, and quality-based payments. In addition, states operate 30 health home programs that focus on coordinating care for people with chronic conditions like obesity, diabetes and mental health conditions. Over the last several years, sates have undertaken significant efforts through State Innovation Models, integrated care models, and delivery system reform incentive programs to create alignment with physicians and hospitals to provide the highest quality of care. And we have proven that when we and states dedicate ourselves to changing the delivery of care, we get results. Consider the role Medicaid has played in supporting seniors and people with disabilities to receive care in their communities. Twenty years ago, more than 80 percent of Medicaid spending on long-term services was on institutional care. Now, thanks to CMS’ and states’ work to make more options available, community-based care has significantly increased. Medicaid has also partnered with several national organizations at the provider, consumer and state levels to help us think through ways to improve both the delivery and quality of care Medicaid and CHIP provides, such as the March of Dimes, the Medicaid State Dental Association and seven academic Centers of Excellence.
- A platform for innovation. Medicaid innovates more quickly when states have the tools to respond to the needs of their residents. To help support these delivery system reforms through improvements to the coordination of patient care, states, with the support of CMS, are working to update legacy IT systems to ones that leverage proven IT methods. This is key in helping to deploy tools, such as electronic health records, that improve the coordination of patient care, further supporting innovative efforts that lead to smarter spending and healthier people.
Most importantly, Medicaid is there when you need it, for working class families, working Americans, people falling on temporary hard times, or living with a disability. Take Todd, a full time student with two part time jobs in Utah who was recently profiled by the Kaiser Family Foundation . He and his wife, Erin, were uninsured but had a new baby. They learned that Erin and their baby Jane were eligible for Medicaid. “When we found out that my wife and Jane would be covered, it definitely felt like a burden lifted a weight off our shoulders,” Todd said. “We don’t make enough to really take care of ourselves the way we would like to.”
It’s because of people like Todd and Erin and people like you that we have invested so heavily and thoughtfully in Medicaid and put forward the rules we have today, which will also support physicians and hospitals and states in improving service, quality and health for millions of Americans.