NASHP Makes Medicaid Recommendations in Three Areas
Here are the key Medicaid reform recommendations from an expert panel convened by the National Academy for State Health Policy:
1. Eligibility
• Medicaid should provide comprehensive health care coverage for the poorest Americans — all people with incomes at or below the federal poverty level — without regard to age, family structure, or health status. Current requirements to cover children and pregnant women with incomes above the poverty level should be continued. States should continue to be permitted to extend Medicaid eligibility beyond minimum federal requirements.
• States should have more flexibility in determining eligibility, including the ability to simplify eligibility requirements by basing eligibility only on income.
• States should be given new options for setting financial and functional criteria to qualify for long-term care services. They should be permitted to modify income and assets tests to allow those applicants seeking community care who are most likely to use up their resources within a short time of entering a nursing home to qualify for Medicaid financed acute and community care, but not institutional services, while they are still in the community. States also should be permitted to set different functional criteria for institutional and community long-term care services.
2. Benefits
• Medicaid should continue to guarantee all mandatory eligibility groups the comprehensive acute, primary care, and long-term care benefits defined under current law.
• Medicaid rules should allow states more flexibility in benefit design for people with incomes above the national minimum eligibility levels. If a state chooses to offer benefits to an optional group, the state would be required to offer acute and preventive care, but could choose whether to offer long-term care. For an optional group, a state could choose an acute and preventive benefit package that was the same as they provided to mandatory groups, or a less comprehensive benefit package that meets certain benchmark standards.
• Parents of Medicaid-eligible children should be able to choose to enroll their children in the SCHIP program so long as certain enrollee-protection standards are met.
• States should be allowed to convert their home and community-based waivers into an ongoing program within Medicaid, eliminating the cost-neutrality and periodic renewal requirements of the existing waiver system.
3. Financing
• The existing federal-state matching structure should be retained and improved. Federal Medicaid financing should not be converted to a block grant.
• The federal government should provide states with an enhanced match at the SCHIP rate for new costs associated with simplifying and expanding eligibility to include all Americans with income at or below the federal poverty level.
• The formula for federal matching funds should be revised to provide a more timely counter-cyclical response to economic downturns.
• The federal government should provide more support to states for the Medicaid costs associated with low-income people enrolled in Medicare. The increased level of support should be provided in conjunction with efforts to improve care coordination and program management between the two programs.
• States should be given new opportunities to coordinate Medicaid coverage with private employer-sponsored insurance through premium assistance programs. States should be allowed to implement premium assistance programs under a state plan amendment with certain features that now require a waiver, such as policies related to wraparound benefit coverage, wraparound cost-sharing, and crowd-out prevention. Further, states should be allowed to require employers to enroll their Medicaid-eligible employees in the employer’s health plan at times other than the open-enrollment period.
Here are the key Medicaid reform recommendations from an expert panel convened by the National Academy for State Health Policy.
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