Issue Areas

Medicaid's Cup Runneth Over

Published: January 2012

An overflowing cup -- that's what comes to mind when one considers Medicaid's opportunities in 2012 to deliver more access, more quality, and more cost-effective care to its millions of beneficiaries. Yet with Medicaid's rolls swollen by the lingering economic downturn, its budgets crimped by related pressures at the state and federal levels, and its future obligations obfuscated by Supreme Court deliberations and presidential elections, one might conclude that the overflow refers to the proverbial fire hose from which Medicaid Directors and their counterparts in other agencies and the delivery system are forced to drink.

My meaning is just the opposite. These are times of unprecedented opportunity for Medicaid. Yes, there are challenges aplenty, but judging from our close interactions with leading state Medicaid Directors and their peers, they would just shrug their collective shoulders and say "That goes with the territory." Then, they'd go capitalize on the cup set before them.

It is a privilege to work with these leaders. They bring the requisite experience and the tolerance for ambiguity that Medicaid demands, particularly in states with palpable political ambivalence about the path to health reform. So the fact that the Supreme Court is contemplating the constitutionality of the Affordable Care Act (ACA) and that the nation could make significant changes in the November elections is not what keeps Medicaid's leaders up at night, or gets them up and at 'em in the morning. What motivates them is implementing the law -- whatever the law is -- to give beneficiaries the best and most cost-effective care possible.

The "law" might include separate state-driven mandates about contracting with managed care organizations to care for people with disabilities, or new budget-driven imperatives requiring states to change the way hospitals are paid. It could entail preparing to implement the ACA's Medicaid expansion and insurance exchanges. Most states are going beyond the mandatory elements of the ACA to take advantage of opportunities to integrate care through health homes or duals demonstrations, and some are pursuing groundbreaking innovations in arenas thought by many to be the exclusive purview of Medicare, e.g., accountable care organizations (ACOs).

We appreciate the opportunity to work with Medicaid's leaders as they "break bread" with their federal counterparts and with early innovating health plan, provider, and consumer partners. It creates opportunities for CHCS and its own funding partners to anticipate what might help all of these leaders deal successfully with their overflowing cups. Here are the top issues that we see for them to conquer in the year ahead:

Establishing systems for determining eligibility and enrolling beneficiaries -- old and new;
Bolstering the capacity of Medicaid provider networks to assure access for all beneficiaries, especially the 16 million or so newly eligible adults in 2014;
Creating contracts that support "seamlessness" -- encompassing eligibility, enrollment, benefits, provider networks, etc. -- for individuals and families churning across the publicly subsidized coverage options, i.e., Medicaid, the Basic Health Plan, and the exchange's Qualified Health Plans;
Implementing payment innovations to drive quality rather than quantity, whether in fee-for-service or managed care; and
Overcoming fragmented care for high-need, high-cost populations crossing over multiple parts of the delivery system (e.g., physical and behavioral health) or multiple financing systems (e.g., Medicaid and Medicare).

Tall orders. Full cups. We look forward to helping Medicaid leaders capitalize on these opportunities in 2012 and beyond.

Stephen A. Somers, PhD
Center for Health Care Strategies