Despite a recent federal court
ruling creating some uncertainty about the future of Medicaid expansion,
industry experts express optimism about several recent developments that they
believe will give way to better patient care going forward.
For one, November's midterm election results may spell more
Medicaid expansion, particularly in historically Republican-controlled states.
Voters in three states approved measures to extend Medicaid coverage, and three
Democratic governors unseated Republicans who did not support expansion.
From a policy perspective, given that Congress is "fairly
neutered in the split in the House and the Senate, then the bigger macro level,
seismic changes like per capita caps are probably off the table vs. more
under-the-radar, yet significant impacts you see from a regulatory and even
judicial perspective," predicts Alex Shekhdar at Medicaid Health Plans of
America.
"In terms of patient engagement, payment reforms and so
forth, the biggest tool that the administrator and the secretary have to
effectuate the Medicaid programs is the 1115 waiver," he says, referring
to the demonstration waiver that states can use to make broad changes to their
Medicaid programs or modifications that focus on a specific population or
service over a five-year period. "And [CMS] has indicated that there is no
stop and believes they have the legal authority to continue to push forward on
the waivers."
"I think the tide has turned and the red states realize
that Medicaid is an important part of the continuum of health care in the
U.S.," weighs in Jerry Vitti, CEO of Healthcare Financial, Inc. "But
I also see the potential for more work requirements, lockout periods and
premiums, copayments, deductibles…and I think there will be a continued push to
get those approved" via 1115 waivers. As a result, Medicaid managed care
organizations may see a "burst of enrollment" from expansion,
followed by churn due to various requirements that make it difficult for people
to maintain coverage, he predicts.
Meanwhile, states and plans are hoping for more leeway to
address social determinants of health, adds Vitti.
HHS Sec. Alex Azar in public comments last fall hinted at a
possible demonstration addressing social determinants through the Center for
Medicare and Medicaid Innovation. Given some of the work already being done by
Medicaid MCOs to address housing and other non-medical factors through local
partnerships, CipherHealth's Friso van Reesema says he is optimistic that CMS
will "follow suit" and start reimbursing for those types of services.
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