CMS Leaders Outline Vision Medicaid, CHIP

Medicaid Centers and Medicare Services are developing a federal minimum standard for access to health care and Medicaid opt-out guidelines, and are working with states to improve redefinition of eligibility, according to senior agency officials.

CMS Administrator Chiquita Brooks-LaSure and Director of the Medicaid Center and Children’s Health Insurance Program Daniel Tsai wrote Blog post for Health Affairs, in which the agency’s agenda for these programs is categorized into three areas: expanding coverage and access, increasing equity, and encouraging innovation.

Medicaid enrollment skyrocketed during the COVID-19 pandemic, in part due to the requirement that states must maintain their lists for additional federal funds during a public health emergency. According to the latest data from CMS, as of May, Medicaid has reached over 80 million people.

CMS can and should do more so that beneficiaries can truly access health care when needed, Brooks-LaSour and Tsai wrote. In a blog post, the agency will explore the possibility of establishing a single minimum standard of access for Medicaid and CHIP recipients and will work with states to develop a strategy.

Coverage does not necessarily mean access to providers and health care, and CMS needs to change that, Brooks-LaSour said at the National Association of Medicaid Directors conference on Tuesday.

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The CMS is developing a clear set of guidelines for 1,115 waivers that allow states to change their Medicaid programs, which contributes to health equity and financial management, officials wrote in Health Affairs. They wrote that withdrawals should aim to expand coverage, promote value-based care, and improve access to home care, mental health care, and treatment for substance use disorders.

CMS also looks forward to re-determining eligibility for renewal following the end of the public health emergency. The agency’s Consumer Information and Insurance Supervision Center works with government officials to prepare them for redetermination and refer inappropriate people to other forms of insurance. The CMS has already provided guidance informing states that they have a year from the end of the public health emergency to complete redefinitions.

“As we approach the end – at some point – of the pandemic, we are very, very focused on making sure we work with states on all the operational details of Medicaid / CHIP renewal and ensure that everyone who is eligible for Medicaid continues coverage, ”Tsai said at the Medicaid Directors’ Conference. “This will and remains one of our top priorities.”

Another key goal is to close the so-called Medicaid coverage gap. The approximately 4 million low-income people in states that have not expanded Medicaid under the Affordable Care Act do not have access to Medicaid benefits or subsidized health insurance plans. President Joe Biden and Democratic leaders in Congress are trying to push forward a domestic policy bill that would provide exchange subsidies for people in the Medicaid gap.

CMS leaders also set a goal to improve access to home and community services and stressed that states can access funding under the American Rescue Plan Act. Democrats are seeking to add $ 150 billion to this initiative through the same law.

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