More on Policy and Legislation

AHIP wants Congress to enact MACPAC recommendations to streamline managed Medicaid

MACPAC also wants more guidance on the implementation of telehealth and weighs in on DSH payments.

Susan Morse, Senior Editor

America's Health Insurance Plans is endorsing measures to streamline the Medicaid managed care program recommended by the Medicaid and CHIP Payment Access Commission.

In its report to Congress on Thursday, MACPAC recommended that the federal government allow states more flexibility and give guidance not only on the use but in the implementation of telehealth. MACPAC also gave its analysis of the government's two-year delay in cutting disproportionate share hospital funds, saying it found little correlation between DSH payments and the amount of uncompensated care.

Managed care in Medicaid is now dominant over fee-for-service,   with over 80 percent of beneficiaries receiving their healthcare through some type of managed care program, MACPAC said.

State officials could more easily implement Medicaid managed care programs if federal policy allowed them to require all beneficiaries to enroll, MACPAC said. Also, approval and waiver renewal periods should be extended from two to five years and there should be waivers to improve the selection of contracting, said MACPAC Chair Penny Thompson in a letter to Vice President Mike Pence, as president of the Senate, and to Speaker of the House Paul Ryan.

AHIP said it agrees that states should have a more streamlined mechanism for adopting and expanding their programs.

"We encourage Congress to enact legislation in line with MACPAC's recommendation and build upon the successes of Medicaid managed care," AHIP said.

On telehealth, the federal government has few restrictions to adopt coverage but its policy offers little guidance about implementation, according to the MACPAC report. As a result, decisions vary on what's covered for telehealth, from live video to remote patient monitoring.

Medicaid serves an estimated 80 million people, and not just women and children, said AHIP President and CEO Marilyn Tavenner.

The program also involves more than healthcare services, she said.

Medicaid managed care means also dealing with issues such as transportation to and from appointments, help with housing and having care workers in the home rather than moving individuals towards an institution.

"It's really much more than just health services," Tavenner said. "It's about the whole socio-economic status of an individual."

Medicaid health plans in 38 states connect Medicaid members to community resources for long-term housing, reliable transportation, and access to healthy food, Tavenner said.

MACPAC said in the report that it finds little relationship between DSH allotments and the numbers of uninsured or the amount of  uncompensated care costs for hospitals.

"Total hospital charity care and bad debt continue to fall, especially in states that expanded Medicaid coverage," MACPAC said. "We also find a Medicaid shortfall as a result of increased Medicaid enrollment. Now that Congress has delayed DSH allotment reductions for two years, the commission will explore opportunities to improve the targeting of DSH payments in future reports."

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