2017 was an incredible year for Medicaid – on the one hand it was challenged with extraordinary proposed cuts and changes, and on the other hand it was highlighted and educated about more than it possibly ever has been since its creation. After 2017, it leaves many wondering what’s next with Medicaid? It’s our job on the Government Relations Team to do our best to predict what is next in the Medicaid arena – and even more so to know where to look for what is next. So here is our best take.
Towards the end of 2017 we heard rumblings of entitlement reform tipping off 2018 by the Senate and House leadership and also in the White House, but those seemed to quiet down after tax reform passed and there was a sense that bipartisan entitlement reform would not be a possibility. Even so, we know that there is desire within the Republican party to slow the growth of Medicaid which is what a per capita cap formula seeks to do (it would match it to some measure of growth like CPI-Medical, CPI-Urban or CPI-Medical plus 1% - familiar calculations that we got to know during the healthcare debates). The idea of “slowing the growth of Medicaid” has persisted post Graham-Cassidy proposal discussions in September and was even most recently given attention by Secretary of HHS nominee Alex Azar in his confirmation hearing in January. We expect this theme and policies driving this theme will subsist.
Whether Congressional entitlement reform moves forward will be, we believe, a big discussion at the Republican Congressional Retreat kicking off January 31 in West Virginia. There are Congressional members on all sides of the issue and to make it even more interesting, it’s an election year (all House seats and 1/3 of Senate seats are up for election in November 2018) which makes these political decisions all the more sensitive.
In terms of where the Administration is with Medicaid, our three Government Relations policy themes for 2018 are managed care, accountability and state flexibility. All three themes relate back to our predictions for Medicaid in the next year. We believe we will see more focus on managed care entities and encouraging their operation in states (which is why CMS announced they are revisiting the 2015 Managed Care Rules this year). We also believe we’ll see more focus on the accountability of Medicaid programs including oversight - which is why two of the main issues we are focused on right now are electronic visit verification compliance for 2019 and the Office of Inspector General investigations out of four states that are now moving into six additional states on critical incident reporting in group homes for I/DD. Notably, though, both of these initiatives were initiated before the new Administration but their impact will be attributed to the current one. The Trump Administration wants to issue Medicaid scorecards, however, indicating the federal branch expects states to be accountable for successful, efficient and responsible Medicaid programs.
Finally, state flexibility is a key goal and theme of the Trump Administration. We are seeing the encouragement of 1115 demonstration projects with unique flexibilities perhaps paving the way to different payment models that are values and outcomes based and the opening of doors for states to implement policies like workforce requirements. In our specific space, we are seeing the Administration wanting to provide more flexibility for the HCBS Settings Rule by extending the state transition period by three years and committing to providing greater clarity for states on the heightened scrutiny process of the rule through subregulatory guidance.
We are aware, of course, that policy trends are unpredictable and can shift in different directions. But by all predictors, we are entering a new phase of the Medicaid program and thus ANCOR is working hard to create opportunities for disability service providers while also protecting the core program that has proven its worth for almost four decades. If you are interested in the latest developments impacting Medicaid, make sure you read our weekly ANCOR Capitol Correspondence on Monday afternoons and consider joining our Government Relations Committee to be part of these important federal policy decisions!
Esmé Grant Grewal is the Vice President of Government Relations at ANCOR. She can be reached at [email protected].