Opportunities for FQHCs in Medicaid Reform: A View from the States

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Opportunities for FQHCs in Medicaid ReformA
View from the States

• Martha Roherty
• January 2007

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2006Significant Year in Medicaid

• Part D Implementation
• Passage of the Deficit Reduction Act
• 36 Governors up for election

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Medicaid Services

• Comprehensive coverage for 28 million children
• Prenatal care and delivery for over 1/3 of the
  births in the U.S.
• Largest provider of mental health care
  servicespaying for nearly half of all mental
  health services

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Medicaid Services

• Administered jointly by the states and
  territories
• Each state program is run independently
• Establishes own eligibility standards
• Determines services
• Sets the rates
• Administers own program

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Passage of the Deficit Reduction Act

• 4.8 billion in savings over 5 years
• Included in the DRA
• Benchmark benefit package
• Cost sharing
• Long-term care changes
• Pharmacy changes
• Fraud and Abuse

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Deficit Reduction Act, cont.

• Citizenship and Identity verification
• Additional funding opportunities

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Administrations Budget Proposals

• Four Budget Proposals
• Provider Tax Restrictions
• Redefinition Rehabilitation Option
• Restricting School-based Health
• Restricting Intergovernmental Transfers

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Part D implementation

• Major shift for duals
• States stepped in to cover those who were unable
  to get Part D coverage
• States lost ability to view drug utilization data
• States still required to pay for the costs of the
  drugs

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Election Results

• 36 Governors up for election
• Majority of Governors now Democrats
• Major shift in Medicaid directors

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HRSA Goal 1 Improving Access to Health Care

• Covering More Children
• Illinois
• Pennsylvania
• Covering More Uninsured
• Massachusetts
• Illinois
• Vermont
• Florida

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Covering More Uninsured

• 3 states created programs in 2006
• At least 16 states have indicated that they are
  exploring ways of covering more uninsured in the
  coming year
• Common features
• Focus on low-income working poor
• Provides a basic package of services
• Includes crowd out provisions

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Covering More Uninsured

• Employer Sponsored Insurance - Partnership
  between the states and employers
• Methods-
• Pay premiums for ESI if recipient is eligible for
  Medicaid
• Allow those without insurance to opt in to the
  Medicaid program and pay a premium for Medicaid

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Covering More Uninsured

• Priority for Governors across the states
• California
• Colorado
• Connecticut
• New Jersey
• New York
• Oregon
• Washington

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HRSA Goal 2 Improving Health Outcomes

• Redesigning State Medicaid Programs
• West Virginia
• Idaho
• Kentucky
• Kansas
• Disease Management
• Care Coordinators
• Medical Homes

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Goal 2 Improving Health Outcomes

• Disease management
• Obesity
• Diabetes
• Asthma
• Heart Disease

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HRSA Goal 3 Improving the Quality of Health Care

• Transparency-websites on quality, pricing, and
  outcomes
• Pay for Performance-medication compliance, E.R.
  utilization, physician referrals
• Medical Homes-focusing on developing a plan of
  care for each patient

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HRSA Goal 4 Eliminating Health Disparities

• Medicaid and Tribal health work groups
• Multi-state collaborations

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HRSA Goal 5 Improving the Public Health and
Health Care Systems

• Systems redesign
• Coordination between Medicare and Medicaid
• Care Coordination

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Goal 6 Enhancing the Ability of the Health Care
System to Respond to Public Health Emergencies

• Katrina relief
• Waivers to provide services without interruption
• Pandemic flu preparedness

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HRSA Goal 7 Achieve Excellence in Management
Practices

• Systems design
• Medicaid is efficientbut is constantly striving
  for additional efficiencies

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2007 Outlook Results of Annual Survey

• Three components
• What actions do you think that your state will
  take in Medicaid in the next year?
• What actions are you most concerned about from
  the Administration?
• What actions are you most concerned about from
  Congress?

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State Trends for 2007
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Other Upcoming Trends Activities

• Increased Care Coordination
• Integration of Services
• Universal Health Coverage
• Health Assessments
• Improved Behavioral Health Services

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Results of the 2005 Survey
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• Key Federal Administrative and Regulatory Issues

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Most Important Federal Administrative/Regulatory
Issues
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Other Key Administrative/Regulatory Issues

• Medicaid Integrity Program
• Changes in FMAP for Psychiatric Residential
  Treatment Facilities
• CMS Waiver Renewals
• Retroactive Medicare Buy-In
• Imbalance of adding CMS audit staff versus
  technical support for states
• Burdensome Home and Community Based Waiver
  requirements
• Therapeutic Group Homes and Therapeutic Foster
  Care reimbursement structures as they relate to
  the to rehab option

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• Key Federal Congressional Issues

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Number 1 Ranked Most Important Federal
Congressional Issues
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Number 2 Ranked Most Important Federal
Congressional Issues
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Other Key Congressional Issues

• Integration of Medicare and Medicaid services,
  including financing, delivery, and administration
  of primary, acute, long-term care, social and
  behavioral health services
• Sunset laws that threaten Medicaid, SCHIP, and
  other programs
• Declining FMAP

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