Medicaid section 1115 waivers Archives - Safety-Net Association of Pennsylvania

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

The following is MACPAC’s own summary of the sessions.

The Medicaid and CHIP Payment and Access Commission kicked off its December meeting with highlights from its forthcoming issue of MACStats: Medicaid and CHIP Data Book, due out December 18, 2019. MACStats brings together statistics on Medicaid and State Children’s Health Insurance Program (CHIP) enrollment and spending, federal matching rates, eligibility levels, and access to care measures, which come from multiple sources.

Later the Commission discussed a proposed rule that the Centers for Medicare & Medicaid Services issued in November, which—among other changes—would increase federal oversight of Medicaid supplemental payments. The final morning session addressed payment error rates in Medicaid, with a briefing on the annual Department of Health and Human Services Agency Financial Report (AFR). Fiscal year 2019 was the first time that the AFR incorporated eligibility errors since the Patient Protection and Affordable Care Act’s Medicaid eligibility and enrollment changes took effect in 2014.

After lunch, MACPAC staff summarized themes from expert roundtables convened in November, one to explore Medicaid policy on high-cost specialty drugs and another on the need for more actionable Section 1115 demonstration evaluations. Then, the Commission turned its attention to Medicaid estate recovery policies. The final session of the day looked at issues associated with reforming the current Medicaid financing structure to better respond to economic downturns.

At Friday’s opening session, the Commission considered policy options to increase participation in Medicare Savings Programs, which provide Medicare cost-sharing assistance to beneficiaries who are dually eligible for Medicaid and Medicare. Afterward, the Commission continued its examination of care integration for dually eligible beneficiaries, this time focusing on policy options to reduce barriers to integrated care. The Commission then switched gears for a briefing on a new MACPAC analysis of Medicaid’s role in financing maternity care. The December meeting concluded with a review of the draft chapter for the Commission’s March report to Congress analyzing disproportionate share hospital (DSH) payments.

Supporting the discussion were the following briefing papers:

Because they serve so many Medicaid and CHIP patients – more than the typical hospital – MACPAC’s deliberations are especially important to Pennsylvania safety-net hospitals.

MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide variety of issues affecting Medicaid and the State Children’s Health Insurance Program. Find its web site here.

PA Safety Net Admin2019-12-17T06:00:54+00:00December 17th, 2019|DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals|Comments Off

The Role of Medicaid in Addressing Social Determinants of Health

Medicaid can play a major role in addressing the social determinants of health.

Or so argues a recent post on the Health Affairs Blog.

According to the post, social determinants of health – income, education, decent housing, access to food, and more – significantly influence the health and well-being of individuals – including low-income individuals who have adequate access to quality health care. Medicaid, the post maintains, can play a major role in addressing social determinants of health.

The post outlines the role state Medicaid programs can play in addressing social determinants of health; describes tools for such action such as section 1115 Medicaid demonstration waivers; offers examples of efforts currently under way in some states; and presents suggestions for steps the federal government can take to facilitate such efforts.

Addressing social determinants of health is an especially important issue for Pennsylvania safety-net hospitals because they care for so many more Medicaid-covered low-income patients than the typical hospital in the state.

Learn more from the Health Affairs Blog post “For An Option To Address Social Determinants Of Health, Look To Medicaid.”

PA Safety Net Admin2019-07-12T09:43:03+00:00July 12th, 2019|Federal Medicaid issues, Pennsylvania safety-net hospitals, social determinants of health|Comments Off

MACPAC Meets

The non-partisan legislative branch agency that advises Congress, the administration, and the states on Medicaid and CHIP-related issues met recently in Washington, D.C.
The following is the Medicaid and CHIP Payment and Access Commission’s own summary of its meeting.

The December 2017 meeting of the Medicaid and CHIP Payment and Access Commission began with a brief update on the State Children’s Health Insurance Program (CHIP). Although federal funding for the CHIP expired at the end of September, legislation to renew funding was still pending in Congress. The Commission then heard from a panel discussing state tools to manage drug utilization and spending in Medicaid. Panelists included Renee Williams, director of clinical pharmacy services for TennCare; Doug Brown, Magellan Rx Management’s vice president for Medicaid drug rebate management; and John Coster, director of the Center for Medicaid and CHIP Services Division of Pharmacy at the Centers for Medicare & Medicaid Services. At the final morning session, Commissioners reviewed a draft March 2018 report chapter on streamlining Medicaid managed care authorities. The Commission voted to approve recommendations to Congress, but deferred action on a third recommendation for further discussion at its upcoming January 2018 meeting.

In the afternoon, MACPAC staff previewed highlights from the December 2017 MACStats: Medicaid and CHIP Data Book. MACStats pulls together Medicaid and CHIP data from multiple sources that often can be difficult to find. The collection is published annually and individual tables are updated throughout the year. The Commission then reviewed the draft March report chapter on telemedicine in Medicaid, and later in the day the Commission returned to the topic of prescription drugs, to explore potential recommendations on the Medicaid drug rebate program.

The final December sessions covered MACPAC’s annual analysis of disproportionate share hospital payments (a required element of its March reports), and findings from interviews with four states to better understand how they are implementing Section 1115 Medicaid-expansion waivers.

The following presentations, many with supporting documents, were offered during the MACPAC meeting:

PA Safety Net Admin2017-12-19T06:00:26+00:00December 19th, 2017|Federal Medicaid issues|Comments Off

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met recently in Washington, D.C.
Among the issues MACPAC commissioners discussed during their two-day meeting were:

delivery system reform incentive payment programs
Medicaid enrollment and renewal processes
managed care oversight
monitoring and evaluating section 11115 demonstration waivers
Medicaid coverage of telemedicine services

MACPAC advises the administration, Congress, and the states on Medicaid and CHIP issues. It is a non-partisan agency of the legislative branch of government.
Go here to find background information on these and other subjects as well as links to the presentations that MACPAC staff made to the commissioners during the meetings.

PA Safety Net Admin2017-09-21T06:00:10+00:00September 21st, 2017|Federal Medicaid issues|Comments Off

MACPAC Meets

Last week the Medicaid and CHIP Payment and Access Commission met in Washington, D.C. The agency performs policy and data analysis and offers recommendations to Congress, the Department of Health and Human Services, and the states.
During two days of meetings, MACPAC commissioners received the following presentations:

Federal CHIP Funding Update: When Will States Exhaust Their Allotments?
Review of June Report Chapter: Program Integrity in Medicaid Managed Care
Review of June Report Chapter: Medicaid and the Opioid Epidemic
Medicare Savings Program: Eligible But Not Enrolled
Medicaid Reform: Implications of Proposed Legislation
Preliminary Findings From Evaluations of Medicaid Expansions Under Section 1115 Waivers
Potential Effects of Medicaid Financing Reforms on Other Health and Social Programs
Review of June Report Chapter: Analysis of Mandatory and Optional Populations and Benefits
Managed Long-Term Services and Supports: Network Adequacy for Home and Community-Based Services
Update on MACPAC Work on Value-Based Payment and Delivery System Reform

For links to all of these publications and a transcript of the two-day meeting go here, to the MACPAC web site.

PA Safety Net Admin2017-05-05T06:00:59+00:00May 5th, 2017|Federal Medicaid issues|Comments Off

Variations on Medicaid Expansion

While most states that have taken advantage of the Affordable Care Act’s Medicaid expansion have simply expanded their existing Medicaid programs to incorporate the newly eligible, six states have taken a different path, pursuing what are known as section 1115 waivers – waivers of formal Medicaid requirements – to expand their Medicaid programs in different ways.
Typically, those different ways involve coverage modeled on private sector insurance practices, including requiring the newly eligible to choose from among approved managed care plans on the private market; the elimination of some traditional Medicaid benefits; the imposition of work requirements and higher premiums; and more.
In the new report Medicaid Expansion, The Private Option and Personal Responsibility Requirements: The Use of Section 1115 Waivers to Implement Medicaid Expansion Under the ACA, the Urban Institute takes a close look at the six states that have taken this alternative path; among the states reviewed is Pennsylvania and its now-discarded “Healthy Pennsylvania” Medicaid expansion plan. In addition, the Commonwealth Fund has published “The Promise and Pitfalls of Alternative State Approaches to Medicaid Reform,” a commentary on the efforts of the states that have followed this alternative path.

PA Safety Net Admin2015-06-17T06:00:02+00:00June 17th, 2015|Affordable Care Act, Healthy PA, Pennsylvania Medicaid policy|Comments Off

GAO Examines Medicaid Section 1115 Waivers

The U.S. Department of Health and Human Services (HHS) frequently exercises the authority granted to it under section 1115 of the Social Security Act to authorize Medicaid expenditures for uses not strictly permitted under that law if those uses extend Medicaid coverage to populations not already served by Medicaid or promote Medicaid objectives.
Pennsylvania’s Medicaid program has long taken advantage of section 1115 waivers.
At the request of the chairmen of the Senate Finance Committee and the House Energy and Commerce Committee, the U.S. Government Accountability Office (GAO) examined recently approved section 1115 waivers to evaluate whether those waivers met the criteria for the exemptions and whether the documents HHS issues when approving those waiver requests adequately convey what the approved expenditures are for and how they will promote Medicaid’s objectives.
As part of its investigation, GAO reviewed waiver requests from 25 states covering 150 programs and found that HHS lacked formal, written criteria for waivers and suggested that the agency more clearly express, in its approval documents, the objectives it expects programs to achieve in return for their exemption from some federal Medicaid requirements.
For a closer look at the study and its findings, see the report Medicaid Demonstrations: Approval Criteria and Documentation Need to Show How Spending Furthers Medicaid Objectives here, on the GAO web site.

PA Safety Net Admin2015-05-19T06:00:33+00:00May 19th, 2015|Pennsylvania Medicaid policy|Comments Off

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