Transformation

With close to 70 million beneficiaries, Medicaid is the largest government-sponsored health insurance program. According to CMS, over the next 10 years Medicaid expenditures will reach approximately $921 billion and enrollment will grow to almost 78 million beneficiaries.

Consequently, this growth alone will drive calls for system transformation. Moreover, as Medicaid continues to evolve, states are expected to leverage managed care and alternative care delivery approaches to manage costs in their Medicaid programs.

MHPA's Best Practices Letter to the Hill

On November 14, 2014, MHPA sent a letter to the Senate Finance Committee and House Energy and Commerce Committee on best practices in nine areas of Medicaid managed care, including rate-setting, care coordination, encounter data accuracy, quality measurement, and program integrity. The letter is a response to a bipartisan letter sent to MHPA and other associations asking for the best practices submission.

MHPA’s letter highlights the benefits of Medicaid managed care as a payment and delivery system compared to fee-for-service and PCCM models. MHPA describes specific best practices, mostly obtained from MHPA’s newly released 2014-2015 Best Practices Compendium, spearheaded by health plans and states in each of the categories. Read the full letter.

MHPA Submits Comments on the Basic Health Program Proposed Rule

On November 25, 2013, MHPA submitted comments on the Federal Register proposed rule on the Basic Health Program (BHP), published on September 25, 2013. MHPA offered a list of issues for CMS to consider as they draft the BHP Final Rule including administrative funding, its BHP "Blueprint," medical loss ratio (MLR) requirements and solvency standards, standard benefits coverage, 2015 exemption of competitive contracting process, risk adjustment, and geographic implementation. Read the full letter.

MACPAC Key Medicaid Reform Proposals (May 2016)