Time to Move Forward with a True Medicaid Reform | Mental Health America

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Time to Move Forward with a True Medicaid Reform

By Paul Gionfriddo, MHA President and CEO, and Nathaniel Counts, J.D., MHA Senior Policy Director

Medicaid is an expensive program.  For elders in nursing homes, for adults with chronic conditions, and for children with health care needs, it is also a life-saving one.

Among the many messages the House of Representatives sent in its passage of the American Health Care Act (AHCA), it sent this one – the majority does not value Medicaid at the level of its current spending.

What can be done about this?  Can Medicaid spending be cut and future growth be limited, without throwing millions of people off the Medicaid roles?

At MHA, we think it can, and we know the way to do it.

Here is our recommendation:

  • Congress should mandate that the Centers for Medicare and Medicaid Services (CMS), which oversee the Medicaid program,  review current or proposed state plan amendments, waivers, managed care practices, and other innovations, and identify those that improved health outcomes. All of these – when successful – are successful in part because they reduce Medicaid spending.
  • Among those policies and practices that are identified as improving health outcomes, the Office of the Actuary shall identify those that reduced or are predicted to reduce the federal deficit.
  • From those, CMS shall identify those that may be implemented in other states with opportunities for comparable savings. The Office of the Actuary shall determine the predicted reduction in the federal deficit for appropriate states to implement the policy or practice.
  • CMS shall recommend that the state implement the policy or practice. If the state chooses to implement the policy or practice, then CMS shall offer technical assistance to ensure that the state maximally improves health outcomes and reduces the federal deficit in doing so. If the state responds with a valid reason for why implementation of the policy or practice would not be appropriate, then CMS shall move on to the next opportunity for savings.
  • If the state fails to respond with a valid reason for not implementing the policy or practice and takes no action, then CMS shall reduce its federal matching payments to the state by the amount that the Office of the Actuary predicted the policy or practice would have reduced the federal deficit.

In addition, in our proposal:

  • There would be no predicted reductions in the number of Americans covered by public or private health insurance;
  • There would be no reductions in the scope of mental health and substance use benefits provided under public or private health insurance; and
  • There would be no increases in health care costs for low-income Americans.

This approach would work for everyone. The federal and state governments would save money, outcomes for people would improve, and no one would be cut from his or her lifeline. It would make sense.

At MHA, we have been at the forefront of advocating that health care reforms take us forward, not backward, building on the progress we made in parity and acting Before Stage 4 in the 21st Century Cures Act.

AHCA does just the opposite.  But the Senate has the chance to start over and do something meaningful, backed up by years of Congressional initiative and analysis – in other words, by investing in evidence-based approaches to policymaking. 

This as an opportunity. It’s up to policymakers to make the right choice.


Maybe CMS try to assist that state in overcoming or adjusting in a manner that allows it to participate, then, if CMS finds a valid reason for not implementing the policy they move on? What mode of investigation would the actuary take to ensure the reason truly is valid since they are relying on states to provide evidence against themselves? Does the evidence in evidence based reports get its own investigation? I agree that costs can be cut at the state levels without covering less people if states are highly motivated.

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