CMS Takes Steps to Reform Medicaid


New policies can help increase flexibility to improve Medicaid.

The Centers for Medicare & Medicaid Services (CMS) recently revealed several potential steps that can be taken to reform Medicaid.

During a session at the National Association of Medicaid Directors Fall Conference, CMS Administrator Seema Verma discussed the future of Medicaid and policies that aim to foster innovative reforms, reduce burdens, increase efficacy, and improve transparency and accountability, according to a press release.

When Medicaid was first implemented, it was meant to provide aid to the most vulnerable Americans. Due to the growth of the program over the past few years and corresponding federal funding increases, regulation also increased, according to Verma.

“Our vision for the future of Medicaid is to reset the federal-state relationship and restore the partnership, while at the same time modernizing the program to deliver better outcomes for the people we serve,” Verma said. “We need to ensure that we are building a Medicaid program that is sound and solvent to help all beneficiaries reach their highest potential.”

Verma also said she supported giving states more freedom to implement innovative strategies that result in positive results for patients and remove barriers for states, according to the session.

The CMS plans to enact several new policies and initiatives to reduce regulatory burdens that hinder innovation and improvement:

Revising the Website

The CMS updated its website to provide states with guidance on how to better align with the core values of Medicaid. The website content includes a broader view of Section 1115 demonstrations, a program in which states can focus on evidence-based interventions that improve outcomes and quality of life, according to the release.

The website update demonstrates the desire of CMS to partner with state officials to provide high-quality services, support independence, and advance delivery and payment models, according to Verma.

In line with these efforts, Verma stressed the CMS’ commitment to consider proposals that would focus on bringing working-age, able-bodied Medicaid beneficiaries out of poverty through community engagement and other activities, according to the session. Verma said that since Medicaid enrollment has increased, the needs of this population are significant.

“Every American deserves the dignity and respect of high expectations and as public officials we should deliver programs that instill hope and say to each beneficiary that we believe in their potential,” Verma said. “CMS believes that meaningful work is essential to beneficiaries’ economic self-sufficiency, self-esteem, well-being, and health of Americans.”

Streamline the 1115 Demonstration, State Plan Amendments, and 1915 Waiver Process

Recently, the CMS released new policies that aim to enhance program management through improvements in the review, approval, and monitoring of the state plan amendments (SPA) and 1915 waivers for the 1115 Demonstration, Medicaid, and the Children’s Health Insurance Program (CHIP), according to the release.

The revisions will allow:

  • Approval for 1115 demonstrations for up to 10 years
  • Easier pursuit of fast track federal review
  • Administering demonstrations by reducing reporting requirements
  • Accelerate SPA and 1915 waiver efforts through streamlining and an initial call with CMS within 15 days

Overall, the policies were implemented to reduce burden on states, mitigate costs for taxpayers, and refocus resources on Medicaid beneficiaries, according to the release.

Medicaid and CHIP Scorecards

The CMS is currently working on developing the first-ever scorecards for the programs with a goal of increasing transparency and accountability. Under this change, state and federal Medicaid outcomes will be published.

During the session, Verma said that scorecards were an opportunity to outline how tax dollars were being spent and how that corresponds with improved health outcomes for patients.

Verma closed by stressing the Trump administration’s new vision for Medicaid and how these changes can improve the program, according to the session.

“We will not just accept the hollow victory of numbers covered [in the program], but will dig deeper and demand more of ourselves and of you,” Verma said. “For those unable to care for themselves, we will create sustainable programs that will always be there to provide the care you need, to provide choices and allow you to live as independently as possible. For those that just need a hand up, we will provide you the opportunity to take charge of your healthcare and assist and empower you to rise out of poverty and government dependence to create a better life for yourselves and your family.”

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