Financing Changes and Added Flexibility for Medicaid. Matt Salo, Executive Director May 24, th Princeton Conference

Transcription

1 Financing Changes and Added Flexibility fr Medicaid Matt Sal, Executive Directr May 24, th Princetn Cnference

2 Natinal Assciatin f Medicaid Directrs Created in 2011 t supprt the 56 state and territrial Medicaid Directrs Standalne, bipartisan, & nnprfit Cre functins include: Develping cnsensus n critical issues and leverage Directrs influence with respect t natinal plicy debates; Facilitating dialgue and peer t peer learning amngst the members; and Prviding effective practices and technical assistance tailred t individual members and the challenges they face. 2

3 What is Medicaid? Natin s main public health insurance prgram fr peple with lw incme Cvers rughly 74.4 millin peple, including 35.8 millin children 1 Single largest surce f public health cverage in the U.S. Accunts fr 16% f natinal health spending 2 Cre surce f financing fr: Safety-net hspitals Health centers that serve lw-incme cmmunities Nursing hmes Cmmunity-based lng-term care 1. CMS, Medicaid & CHIP: Nvember 2016 Mnthly Applicatins, Eligibility Determinatins and Enrllment Reprt (January 18, 2017): link 2. MACPAC, Histric and Prjected Natinal Health Expenditures by Payer fr Selected Years, (December 2015): link 3

4 Wh is in Medicaid? Estimated Enrllment by Ppulatin Categry, Fiscal Year Aged 8.2% Expansin adults 13.3% Persns with disabilities 15.3% Adults 22.2% Children 41% 1. Centers fr Medicare & Medicaid Services, Office f the Actuary, 2016 Actuarial Reprt n the Financial Outlk fr Medicaid (2016). 4

5 Hw much des it cst? Ttal Medicaid spending ( ): FY 2013: $440 billin 1 FY 2014: $496.3 billin 2 FY 2015: $509 billin 3 Almst tw-thirds f all Medicaid spending fr services is attributable t the elderly and persns with disabilities, wh make up just ne-quarter f all Medicaid enrllees. 4 Dual eligible beneficiaries alne accunt fr almst 40% f all spending, driven largely by spending fr lng-term care. The 5% f Medicaid beneficiaries with the highest csts drive mre than half f all Medicaid spending. Their high csts are attributable t their extensive needs fr acute care, lng-term care, r ften bth Kaiser Family Fundatin, Medicaid Mving Frward (March 9, 2015): link 2. Centers fr Medicare & Medicaid Services, Office f the Actuary, 2015 Actuarial Reprt n the Financial Outlk fr Medicaid (2015) 3. Kaiser Family Fundatin, Medicaid Enrllment & Spending Grwth: FY 2016 & 2017 (Octber 2016): link 4. Kaiser Family Fundatin, Medicaid Mving Frward (March 9, 2015): link 5. Ibid. 5

6 State f Play f Current Envirnment Pst 2016 electin, significant changes frm previus 8 years Three frnt burner issues: 1. Repeal and replace f Affrdable Care Act (Cngressinal) 2. Medicaid as entitlement refrm (Cngressinal) 3. New leadership at HHS and prmise f new state/federal partnership (Administratin) 6

7 Where des NAMD stand in this current state f play? Bipartisan N psitin n repeal and replace N psitin n per capita caps r blck grants N shulds r shuldn ts Key cnsideratins dcuments fr plicymakers Trusted aut mechanic 7

8 NAMD has requested that lawmakers cnsider three main issues in the develpment f any prpsals that wuld change the structure f Medicaid: Statutry Framewrk & Eligibility Financing Federal-State Partnership Natinal Assciatin f Medicaid Directrs 8

9 Statutry Framewrk and Eligibility What are the requirements fr states in the framewrk fr ppulatins cvered, services cvered, and payment levels? Hw will the prpsal impact eligibility and services fr current enrllees? What are the health needs f thse served by Medicaid and hw will thse needs be met under the prpsal? Natinal Assciatin f Medicaid Directrs 9

10 Statutry Framewrk and Eligibility Lng-term care Medicaid is currently the default lng-term care prgram in the United States, and as demgraphics change, mre Americans are expected t need lngterm services and supprts. Dually Eligibles Apprximately 40% f Medicaid spending is fr lwincme Medicare beneficiaries. Safety-net prviders (i.e., FQHCs) Natinal Assciatin f Medicaid Directrs 10

11 Financing What is in the federal funding frmula fr Medicaid prgram grwth and hw is that frmula calculated? What is the state match requirement in the prpsal fr Medicaid? What is in the base used t set the federal match amunt? What is the impact f the prpsal n state appraches t finance the state share f the Medicaid prgram (i.e., prvider taxes, intergvernmental transfers, upper payment limits)? Natinal Assciatin f Medicaid Directrs 11

12 Financing What is in the federal funding frmula that wuld be used during recessins r unfreseen cst surges? Fr example, new develpments in specialty pharmacy and future develpments in bilgics prducing drugs with list prices appraching $500,000 per year. Hw des the prpsal impact the financing structure fr Medicaid IT systems? Hw wuld the financing apprach impact the structure f CHIP, including Medicaid expansin CHIP prgrams, separate CHIP prgrams, r cmbinatin CHIP prgrams? Natinal Assciatin f Medicaid Directrs 12

13 State and Federal Partnership What is the rle f states in prviding input n new federal rules related t Medicaid? What are the areas where additinal state flexibility might be affrded? Hw des the prpsal change the existing Medicaid regulatry structure (i.e., state plans, Sectin 1115 and ther Medicaid waivers)? Hw des it impact existing federal Medicaid regulatins and their implementatin? Natinal Assciatin f Medicaid Directrs 13

14 Reality f the Medicaid Directr Natinal Assciatin f Medicaid Directrs 14

15 Being a Medicaid Directr in 2017 running a Frtune 50 cmpany Directing ~ 25 percent f the state s budget Mnitring the ptential changes at the cngressinal level If refrm mves? If it desn t? Establishing and navigating new relatinships at CMS Aggressively driving value-based purchasing Negtiating multi-millin dllar cntracts with health plans, delivery systems, infrmatin system vendrs, etc. Did I mentin average tenure is 19 mnths? 15

16 What keeps Medicaid directrs up at night? Medicaid as natin s de fact lng-term care plicy And mental health and substance use system Demgraphics and needs in these areas are nly grwing Natinal Assciatin f Medicaid Directrs 16

17 What keeps Medicaid directrs up at night? Discnnect between what Medicaid means t Cngress and the reality f $880 billin in savings Medicaid s cnnectin t ther surces f cverage Medicaid is nt an island Natinal Assciatin f Medicaid Directrs 17

18 Fr mre infrmatin abut NAMD, visit Thank yu.