Renee Markus HodinCommunity CatalystFrom Vision to Reality: State Strategies for Health Reform ImplementationNovember 2010

Payment & Delivery System Reform in Medicaid:

Opportunities in the ACA

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Why Should We Care?

Improve Care For the Most Vulnerable

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Improve Care for Most Vulnerable (cont’d)

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Source: “The State of Health Care Quality”, 2009, NCQA

Sustain the Medicaid Program

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Medicaid is:

• critical to 45 million+ low income and vulnerable people

• the foundation for and key building block of the coverage expansion in 2014

• under enormous fiscal pressure

Sustain the Medicaid Program (cont’d)

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• 46 States plus DC need to close budget gaps

• Aggregate State Budget Shortfall (FY11) =$121 billion

• State revenue still below pre-recession levels

• Continued high unemployment/ growth in poverty drive Medicaid caseload

• Add’l FMAP ending?

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Opportunities in the ACA

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• Grants to promote healthy behaviors in Medicaid (2011)

• $100 million appropriated

• Incentives to cover preventive services in Medicaid (2013)

• 1% increase in state FMAP

New Focus on Prevention

Improve Care Coordination

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• Center for Medicare and Medicaid Innovation (2011 & beyond)

• Federal Coordinated Health Care Office (2010)

• Medical Homes state option (2011)

• 90% FMAP for 1st two years

Explore New Ways to Pay for Care

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• Bundled payments (Oct 2011)

• 8 states

• Global payments (FY2010-FY2012)

• 5 states

• Pediatric ACOs (Jan 2010 – Dec 2016)

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• HCBS State Plan Option Expansion (immediate)

• Money Follows the Person Demonstration Extension (immediate)

• Community First Choice Option (Oct 2011)

• State Balancing Incentive Program (Oct 2011)

Strengthen Long-Term Care

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No federal payments for preventable errors (July 2011)

Reduce Medical Errors

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Key Takeaways

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Key Takeaways

1. Sustaining the Medicaid program is essential work between now and 2014

2. Key to that work is proposing payment & delivery system reforms that improve care while reducing costs (as alternatives to other Medicaid cuts)

3. The ACA includes payment & delivery system reform options, but states must act to take advantage of them – advocates can help!