Jackie Zheleznyak’s Post

We’ve seen this story before: cut health data expenditure than complain about not adequately safeguarding the public’s investment or financial eople’s health. Transforming health care access and delivery required data, lest we prefer now making all decisions on pronouncements.

🚨 CBO Goes #DOGE Wild, Offers Cap to Fed #Medicaid Admin Match Rates At the request of the House and Senate Committees on the Budget, the Congressional Budget Office (#CBO) has released 74 options to reduce the federal budget deficit from 2025 to 2034. It is a cornerstone doc to guide #GoodGovernment decision-making. That said, I want to discuss why the CBO's proposal to cap federal Medicaid match rates for admin expenses at 50% is troubling. First, a primer: to run a state #Medicaid program, you need to have a Medicaid program. You need people, processes, & tech to: ▪️ Enroll low-income kids & adults in coverage; ▪️ Build & manage plan & provider networks (& oversee #MCOs); ▪️ Confirm svc eligibility; ▪️ Manage claims processing; ▪️ Support #HIE, from #EHR adoption to application; ▪️ Oversee & report on system integrity (e.g., detect fraud, waste, & abuse) & performance (e.g., quality measurement), among countless other functions. As part of the federal-state Medicaid deal, the federal govt covers at least half of these costs, w certain functions receiving a higher match rates (e.g., #MMIS claims processing, fraud control, EHR incentives, system upgrades). And despite the bevvy of new federal & state functional and reporting reqs placed on Medicaid prgns, admin costs have remained at ~5% of total spend. (For comparison, private health plan #MLRs allow double that.) Now, this isn't a small number. In FY23, total national Medicaid admin spending was $34.4B, w ~39% of that covered by states, ~61% by the feds. Rebalancing this to 50-50, CBO believes would save $69B over 10 yrs (~$6-8B/yr). But here's the rub: ▶️ The enhanced match is where innovation happens. It is what supports system upgrades, state health infrastructure development -from #HDUs to #APCDs- data improvement & system monitoring. Cutting it would cut the wheat from the chaff, esp for smaller states. ▶️ Smaller states benefit most. For giggles, I ran a quick hit on CMS-64 data (below). Even though admin match rates aren't tied to state income like #FMAPs, the results don't look too different (which raises other Qs for me.) ▶️ There is no alternative. Cutting Medicaid admin costs will only stretch already thin state systems. If the new Admin wishes to empower states, states need effective infrastructure. Alternatively, we could start collaborating -regionally or nationally- on more efficient, shared infrastructure. (My phone is always on.) There is much in the CBO report worth debating, but too often, I find, it is our #healthdata infrastructure that gets short shrift, and is quietly cut in last-minute deals. Our nation needs big, hairy, revolutionary thinking when it comes to how we fix our leaking #healthdata pipes, but cutting funding for our crude model without an alternative is not a solution. h/t MACPAC - Medicaid and CHIP Payment and Access Commission National Association of Health Data Organizations, Civitas Networks for Health https://lnkd.in/eZk_2rFB

Federal cuts are coming but let’s aim them in the right direction! See this great overview of what cutting admin costs to Medicaid programs means for states.

These systems have been problematic from the jump. In my home state it was noted by state MEPD staff…the response?… to fix it on the fly and with training…que billoreillywe’lldoitlive.gif Telos LTC is proud to be on the leading edge of solving this problem. By empowering applicants with the most dynamic eligibility platform out there, we believe we can affect meaningful change in the care received by #medicaid beneficiaries. With the significant delays in cases being worked (pushing 200 days in some states…cough cough Texas) it has never been more important that approval is all but guaranteed at the time of application. A denial going back that far can result in months of lost coverage that can’t be clawed back. This is mission critical for the #longtermcare #nursinghome industry. Battling staffing mandates and loss of Medicaid coverage is going to cause more closures. In rural communities this means our loved ones needing to move for care, more travel for visitation and lost jobs. We can do better.

MACPAC met last week and released new data showing HUGE increases in Medicaid state-directed payments. Make no mistake--it's SDPs for hospitals, funded w/provider taxes and IGTs, driving this growth. MACPAC noted that the link to better HOSPITAL access is tenuous at best for these payments. We'll have a new Congress and Administration in January, and this spending category is surely going to be a target--even if Florida and Texas hospitals are among the biggest beneficiaries of this spending. We've been here before (yeah, I'm old enough to remember). Those of us who care about #Medicaid need to call for hard caps on these payments, more accountability from those who receive them, and shifting them out of expensive hospital systems and into community-based care. And provider taxes must be reformed, too, so that they are more re-distributive and fund a range of high-value services. Rebecca Pifer MACPAC - Medicaid and CHIP Payment and Access Commission #Medicaid

"#Republicans are considering to help finance additional #taxcuts for the rich and large corporations are proposals that would strip #Medicaid coverage from millions of Americans, including children, seniors, and people with disabilities...These funding caps are typically designed to fail to keep pace with expected growth in healthcare costs in order to severely cut federal Medicaid spending, with those cuts growing larger and larger over time...Moreover, the caps would also fail to account for any unexpected cost growth such as from another public health emergency or a new, costly drug therapy, which would make the federal funding cuts even larger than originally anticipated." https://lnkd.in/eBTCJMmX

Gumption Education: Asset Spend Down Asset Spend Down refers to the process of reducing one's countable assets to meet the income and asset thresholds required for Medicaid eligibility. This strategy is particularly important for individuals seeking long-term care services, as it allows them to "spend down" their assets on medical or care expenses until they reach the eligibility threshold. Careful planning and guidance from Medicaid experts are essential to navigate the Spend Down process effectively. Visit the link below to learn more. https://lnkd.in/gVQ-4w4f #medicaid #assetspenddown #medicaideligibility #longtermcare #medicaidplanning #seniorcare #medicaidbenefits #estateplanning #medicaidestate #medicaidrecovery #healthcareexpenses #medicaidsupport

“What I’ve learned and experienced is that #healthcare is part of social justice, and we have to think of it that way. Any other way of thinking of it is going to create winners and losers.“ More #HealthcareReform on the margins via 2024 adjustments to #MedicaidManagedCare. #Medicaid #PublicPrivatePartnership #PublicPrivatePartnerships #HealthcareTransformation

A Look at Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies During the Unwinding of Continuous Enrollment and Beyond: The 22nd annual survey of state Medicaid and CHIP programs officials conducted by KFF and the Georgetown University Center for Children and Families in March 2024 presents a snapshot of actions states have taken to improve systems, processes, and communications during the unwinding, as well as key state Medicaid eligibility, enrollment, and renewals policies and procedures in place as of May 2024. The report focuses on policies for children, pregnant individuals, parents, and other non-elderly adults whose eligibility is based on Modified Adjusted Gross Income (MAGI) financial eligibility rules. #medicaid #mdrp #financial

Medicaid's state-directed payments are soaring, aiming to boost care access but sparking concerns about transparency & creative state financing. With billions in play, are we seeing meaningful impact or missed oversight? Dive into the debate: https://hubs.li/Q02XqGZN0 #HealthcarePolicy #Medicaid