CMS Administrator Seema Verma announced her vision for Medicaid and new policies to encourage states to create innovative programs that improve patient outcomes at the National Association of Medicaid Directors (NAMD) fall conference Tuesday.
Verma said CMS’ policies will encourage states to propose Medicaid reforms, as well as reduce federal regulations, increase efficiency and promote transparency and accountability. Verma said the CMS may approve work requirements for the program. Eight states have requested the CMS allow them to require people who are not disabled to work or provide community service in order to be eligible for Medicaid.
The CMS has updated Medicaid.gov to provide more information that will allow states to know how to align their Medicaid programs with the program’s core objective, which is to serve the health and wellness needs of the most vulnerable, Verma said.
In announcing new Medicaid policies and initiatives to remove regulatory barriers, Verma said she wants to give states more freedom to design programs. She said Medicaid’s federal-state partnership is ready for a reset to modernize the program to deliver better outcomes. She told NAMD that CMS’ changes are a way to “demand more of ourselves and of you.”
There are some concerns with giving states a lot more flexibility, though, and policy experts are particularly worried about work requirements. Most people on Medicaid already work, and others are caring for relatives. Hannah Katch, senior policy analyst at the Center for Budget and Policy Priorities, has said a work requirement policy would serve more as a penalty than an incentive and would likely increase administrative costs for states. "A work requirement would likely reduce the number of people who could access care through Medicaid and there's no evidence that it would increase employment among poor families," she wrote earlier this year.
Verma announced new policies and initiatives, including:
Improve 1115 demonstration, state plan amendments and 1915 waiver processes — The CMS released new policies that will affect the review, approval and monitoring of 1115 demonstrations, Medicaid and Children’s Health Insurance Program (CHIP) state plan amendments and 1915 waivers. The 1915 waivers can give states more flexibility in how federal funding is used for home and community based services.
These provisions include fast-tracking federal review of demonstration programs, fewer 1115 reporting requirements and quickening the state plan amendment and 1915 waiver processes. The CMS said these changes will remove regulatory burdens on states and reduce administrative costs.
Medicaid and CHIP scorecards — The CMS is working on a project to track and publish state and federal outcomes for Medicaid and CHIP. The scorecards will bring greater transparency and accountability for the programs, according to the CMS, which has created similar rating programs for hospitals and Medicare Advantage.
Verma’s speech comes a week after she delivered a talk promoting alternative payment models at the Health Care Payment Learning & Action Network (LAN) fall summit.
At the LAN speech, Verma offered changes to Medicare programs. She said the CMS is revising current quality measures across all of its programs, including the Hospital Star Ratings and MACRA programs. She also announced the Meaningful Measures initiative that will take quality measuring advice from the LAN, National Academies of Medicine, Core Quality Measures Collaborative and National Quality Forum.