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CMS Streamlines Medicaid Review Process and Reduces Approval Times so States Can More Effectively Manage Their Programs

At the Centers for Medicare & Medicaid Services (CMS), we are making great progress to transform Medicaid, which CMS’s largest program serving 72.5 million beneficiaries. We are working to reset the federal-state relationship and restore the partnership between the states and the federal government, while at the same time modernizing the program to deliver better outcomes for the people we serve.

CMS has made significant improvements in administering the Medicaid program in partnership with states. Identified early as a priority for both the Trump Administration and the National Association of Medicaid Directors (NAMD), I charged a CMS team to collaborate with states to make the state plan amendment (SPA) and 1915 waiver review process more transparent, efficient, and less burdensome so we can reduce processing times. This is particularly important as these represent the bulk of approvals states need to receive to make even routine changes to program benefits, rates, and eligibility requirements. When this process doesn’t work, it can create bureaucratic headaches that hinder their ability to effectively manage their program.

Soliciting state input was essential to this process. State feedback was received through a variety of mechanisms to ensure that any process improvement activities were comprehensive and responsive to state needs. To facilitate collaboration, we formed a federal-state workgroup with representatives from more than a dozen states.

The data speaks for itself:

  • Between calendar years 2016 and 2018, there was a 16 percent decrease in the median approval time for Medicaid SPAs.
  • Seventy-eight percent of SPAs were approved within the first 90 day review period during calendar year 2018, a 14 percent increase over 2016.
  • Between calendar year 2016 and 2018, median approval times for 1915(b) waivers decreased by 11 percent, 1915(c) renewal approval times decreased by 38 percent, and 1915(c) amendment approval times decreased by 28 percent.
  • The backlog of pending SPA and 1915 waiver actions pending additional information from the states was reduced 80 percent from previous years.

With faster processing times and earlier communication, states now have much greater ability to manage their programs in an effective and predictable manner. We want to ease bureaucratic requirements for both states and our own staff so that we can focus those resources on improving health outcomes rather than pushing paperwork.

As recognition for the hard work of the CMS team responsible for this great milestone, the team was selected as  one of the first Gears of Government Awards  from the White House Office of Management and Budget. The Award recognizes federal employees across the government that play pivotal roles in achieving the President’s vision for a modern, effective government that works on behalf of the American people. I am proud of the team for their dedication in support of the agency’s mission, exceptional customer service, and accountable stewardship.

While we have made great progress, there is still work to do. The SPA and 1915 waiver review processes represent a substantial workload for both states and CMS. Our partnership  with states on process improvement and the implementation of the new strategies has resulted in more efficient and timely processing of SPA and 1915 waiver actions, reducing administrative burden for states. We have now begun a similar effort to achieve similar improvements in processing times for managed care contracts and rate approvals. These efforts enable states to more effectively manage their programs and ensure that they can focus on their most important job – achieving positive health outcomes for the vulnerable individuals and families the program serves. We look forward to continued collaboration to ensure these processes are transparent, efficient, and less burdensome.

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