1

Cindy Mann, JDCindy Mann, JDCMS Deputy AdministratorCMS Deputy Administrator

DirectorDirectorCenter for Medicaid, CHIP, and Survey & CertificationCenter for Medicaid, CHIP, and Survey & Certification

Alliance for Health ReformAlliance for Health ReformApril 23, 2010April 23, 2010

Putting Reform into Medicaid Putting Reform into Medicaid and Medicaid into Reform: and Medicaid into Reform:

A Two-Way StreetA Two-Way Street

Putting Reform into Medicaid Putting Reform into Medicaid and Medicaid into Reform: and Medicaid into Reform:

A Two-Way StreetA Two-Way Street

The Federal Government The Federal Government is is

here to helphere to help

The Federal Government The Federal Government is is

here to helphere to help Our MissionOur Mission: Help states : Help states

make Medicaid and CHIP the make Medicaid and CHIP the best programs they can bebest programs they can be

States are struggling; but States are struggling; but federal resources and federal resources and support are available nowsupport are available now

The Affordable The Affordable Care Act of 2010Care Act of 2010The Affordable The Affordable

Care Act of 2010Care Act of 2010

Sources of Coverage Sources of Coverage for Non-Elderly (2019)for Non-Elderly (2019)Sources of Coverage Sources of Coverage

for Non-Elderly (2019)for Non-Elderly (2019)

Source: Congressional Budget Office

162m162m162m162m

35m35m35m35m24m24m24m24m54m54m54m54m

30m30m30m30m

Coverage Guarantees Rely on Coverage Guarantees Rely on ESI, Exchange, Medicaid/CHIPESI, Exchange, Medicaid/CHIPCoverage Guarantees Rely on Coverage Guarantees Rely on ESI, Exchange, Medicaid/CHIPESI, Exchange, Medicaid/CHIP

ESIESIESIESI

Medicaid/Medicaid/CHIPCHIP

Medicaid/Medicaid/CHIPCHIP

ExchangeExchangeExchangeExchange

New ParadigmNew ParadigmNew ParadigmNew Paradigm Reform is predicated on the principle that everyone Reform is predicated on the principle that everyone

who is eligible is enrolled; and that coverage is who is eligible is enrolled; and that coverage is stablestable

– Necessary for coverage, cost containment and qualityNecessary for coverage, cost containment and quality

Need to rethink Medicaid enrollment/renewal; Need to rethink Medicaid enrollment/renewal; simplified Medicaid rules and other features of simplified Medicaid rules and other features of reform will make this easierreform will make this easier

Essential to make a Essential to make a system system out of different out of different componentscomponents

Putting Medicaid into Putting Medicaid into ReformReform

Putting Medicaid into Putting Medicaid into ReformReform

A A systemsystem of coverage of coverage across across Medicaid/Exchange/ESIMedicaid/Exchange/ESI

Make “No Wrong Door” Make “No Wrong Door” a realitya reality

A A systemsystem of coverage of coverage across across Medicaid/Exchange/ESIMedicaid/Exchange/ESI

Make “No Wrong Door” Make “No Wrong Door” a realitya reality

MedicaidMedicaidMedicaidMedicaid

Exchange

Exchange

Exchange

Exchange

ESI

ESI

ESI

ESI

Transition to a New Transition to a New Medicaid ProgramMedicaid Program

Transition to a New Transition to a New Medicaid ProgramMedicaid Program

Early option to receive FFP for covering low-income Early option to receive FFP for covering low-income adults beginning April 1, 2010.adults beginning April 1, 2010.– Letter to SMDs released April 9, 2010.Letter to SMDs released April 9, 2010.

Other immediate guidance, e.g.Other immediate guidance, e.g.– Medicaid Drug Rebate changes (SMD released April 22) Medicaid Drug Rebate changes (SMD released April 22) – Maintenance of Effort for Medicaid and CHIPMaintenance of Effort for Medicaid and CHIP

Putting Reform into Putting Reform into MedicaidMedicaid

Putting Reform into Putting Reform into MedicaidMedicaid

Creating a high performing Medicaid ProgramCreating a high performing Medicaid Program– Eligible means enrolledEligible means enrolled– Access issues Access issues – Systems upgrades and Data/Performance Systems upgrades and Data/Performance

measuresmeasures– Payment and delivery systems reformPayment and delivery systems reform– Continuing to make progress “(re)balancing” long Continuing to make progress “(re)balancing” long

term-care service and supportsterm-care service and supports– Assuring program integrityAssuring program integrity

Source: FY MSIS 2008, FY MSIS 2007 for AZ, NC, ND, HI, UT, VT, WI

Source: FY MSIS 2008, FY MSIS 2007 for AZ, NC, ND, HI, UT, VT, WI

Top 5% of Enrollees Accounted for Top 5% of Enrollees Accounted for More than Half of Medicaid Spending in FY 2008More than Half of Medicaid Spending in FY 2008

Top 5% of Enrollees Accounted for Top 5% of Enrollees Accounted for More than Half of Medicaid Spending in FY 2008More than Half of Medicaid Spending in FY 2008

Bottom 95% Bottom 95% of Enrolleesof EnrolleesBottom 95% Bottom 95% of Enrolleesof Enrollees

Collaboration between CMS and Collaboration between CMS and States is EssentialStates is Essential

Collaboration between CMS and Collaboration between CMS and States is EssentialStates is Essential

2010201020102010

Adopt Adopt NewNew

Laws/Laws/BudgetsBudgets

Provider Provider NetworksNetworks/Contracts/Contracts

StaffinStaffingg

TraininTrainingg

Federal Actions

2014201420142014

EligibilitEligibility y

RulesRules

BenefitBenefitDesignDesignss

SysteSystems ms

SuppoSupportrt

Basic Basic OptionOption

System System ChangesChanges

NewNewRules/Rules/FormsForms

DataDataPerformanPerforman

ceceStandardsStandards

Exchange/Exchange/MedicaidMedicaid

Org StructureOrg Structure

FMAP FMAP RulesRules

State Action

New New State State OptionOption

Connecting Kids to Connecting Kids to Coverage ChallengeCoverage ChallengeConnecting Kids to Connecting Kids to Coverage ChallengeCoverage Challenge

Enroll the 5 million uninsured children Enroll the 5 million uninsured children who are currently eligible for Medicaid who are currently eligible for Medicaid or CHIP over the next five yearsor CHIP over the next five years

““We all have a stake in America’s children, and together, We all have a stake in America’s children, and together, we will assure that millions more get the care they we will assure that millions more get the care they need.” need.”

--HHS Secretary Kathleen Sebelius--HHS Secretary Kathleen SebeliusFebruary 4, 2010February 4, 2010

Medicaid Has Always Been a Medicaid Has Always Been a Cornerstone for ReformCornerstone for Reform

Medicaid Has Always Been a Medicaid Has Always Been a Cornerstone for ReformCornerstone for Reform

States have continually relied on Medicaid to meet new States have continually relied on Medicaid to meet new demands and initiate reformsdemands and initiate reforms– Improving infant mortality ratesImproving infant mortality rates– Providing coverage for those living with HIV/AIDSProviding coverage for those living with HIV/AIDS– Covering people with disabilities in the labor Covering people with disabilities in the labor

market, children with special needs, and providing market, children with special needs, and providing community based LTCcommunity based LTC

– Developing new care coordination modelsDeveloping new care coordination models– Initiating Electronic Health Records (EHRs)Initiating Electronic Health Records (EHRs)– Significantly reducing uninsured rate among Significantly reducing uninsured rate among

childrenchildren