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Issues and Challenges in State Medicaid Programs. Ann Clemency Kohler, Director of Health Services National Association of State Medicaid Directors American Public Human Services Association Ann.Kohler@aphsa.org 202.682.0100. States - Laboratory For Health Care Reform.
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Issues and Challenges in State Medicaid Programs Ann Clemency Kohler, Director of Health Services National Association of State Medicaid Directors American Public Human Services Association Ann.Kohler@aphsa.org 202.682.0100
States - Laboratory For Health Care Reform ● Fifty states, Puerto Rico, and the territories are working on health care solutions ● The States are in a unique position to address a variety of health care reform ideas ● Through Medicaid waivers, states have tested various health care initiatives ● States have significant experience with long- term care and community-based models ● States are in the best position to implement innovative ideas and strategies
Federal - State Relationship ● CMS and states need to rebuild partnership ● Relationship needs to be more collaborative ● Partnership is critical with current economy, budget constraints, and plans for healthcare reform ● Interim head at CMSO committed to working with NASMD
Impact of Recession on State Budgets ● Economic downturn and massive job losses are contributing to significant shortfalls in state budgets and increases in Medicaid enrollment ● States must have balanced budgets ● Many states forced to cut funding to Medicaid and other crucial programs ● Every 1% increase in unemployment = 1 million additional Medicaid clients
The American Recovery and Reinvestment Act ● Provides temporary FMAP increase of 6.2 percentage points for 27 months ● Allows additional 5.5 percent, 8.5 percent, or 11.5 percent reduction in the State share of Medicaid costs – determined by unemployment rate ● Creates State Fiscal Stabilization Fund ● Extends Transitional Medical Assistance
The American Recovery and Reinvestment Act ● Increases Supplemental Nutrition Assistance Program funding by $20 billion; ● Places a moratorium on a regulation for outpatient hospital services; and ● Extends existing moratoria on selected Medicaid regulations, including targeted case management; provider taxes; and school based administration and transportation services
SCHIP Reauthorization ● Signed into law February 4, 2009 ● Expands coverage to additional 4 million children ● Requires states to offer dental care through SCHIP, and allows them to extend dental benefits to children who have private coverage that does not include dental coverage ● Requires Mental Health Parity ● Eliminates the five-year waiting period for documented immigrant children and pregnant women to become eligible
Ready for Reform ● Medicaid waivers and SCHIP programs show states can develop high quality affordable health care with low administrative costs ● They can be models to build upon for reform efforts
Dual Eligibles ● Any solution must address the dual eligibles ● Over 7 million duals, 5 million over the age of 65 years ● They represent 29% of Medicare spending and 40% of Medicaid spending ● Much of the Medicaid spending is for long-term care- too often institutional care