Medicaid Experts Recommend Ways to Make the Program More Accessible, Flexible
In 2003 and 2004, a workgroup of 25 experts examined the Medicaid program and made recommendations to improve its efficiency and effectiveness. The National Academy for State Health Policy, the policy arm of the Center for Health Policy Development, convened the workgroup and produced and disseminated the following:
- A final report, Making Medicaid Work For the 21st Century: Improving Health and Long-Term Care Coverage for Low-Income Americans; see the Bibliography).
- Six issue briefs on key topics related to the recommendations contained in the final report; see the Bibliography).
- Simplify and expand Medicaid eligibility to acute and primary care and long-term care.
- Increase program flexibility for optional populations (those groups not automatically covered, such as elderly persons not eligible for Supplemental Security Income (SSI)).
- Improve coordination and integration with the Medicare program and private insurances.
- Adjust current financing mechanisms.
- Provide states with tools to manage long-term care and rebalance institutional and home and community-based care systems.
The Robert Wood Johnson Foundation (RWJF) provided $50,000 in partial funding for this unsolicited project from January through October 2004.
Medicaid, the country's largest health insurer, has undergone significant changes since the early 1990s, but without a systematic review of the program's structure and operations.
In 2003, the National Academy for State Health Policy, a nonprofit, nonpartisan organization that conducts health policy analysis and provides training, technical assistance and information to states, convened a bipartisan workgroup of experts with "in the trenches" experience in the Medicaid program. The Making Medicaid Work for the 21st Century Workgroup (see Appendix for membership) met twice in 2003, and selected three categories for focus:
- benefits and cost sharing
- financing and cost controls.
The Center for Health Policy Development, a nonprofit 501(c)(3) corporation, operates the academy and provides financial oversight. The academy's executive director also serves as president of the center's board of directors. More information is available online.
Staff at the National Academy for State Health Policy:
- Created 11 background working papers to guide workgroup discussion at its third and final meeting in May 2004.
- Dedicated a section of the academy Web site to the Making Medicaid Work for the 21st Century project. (See the Bibliography for details.)
- Drafted a final report of workgroup recommendations for Medicaid program improvement. (See Recommendations and the Bibliography).
- Produced six issue briefs on topics related to the workgroup's final report (available online). (See the Bibliography for details.)
The David and Lucile Packard Foundation ($350,991), AARP ($50,000) and the Agency for Healthcare Research and Quality ($25,000) also provided funding for this project.
The workgroup's final report identifies opportunities for improvement in all areas of the Medicaid program, including calls for:
The National Academy for State Health Policy conducted related sessions at its national conference, under the umbrella title "Expanding Coverage for Adults: State Experiences and Lessons":
- Premium Assistance and Beyond: Working to Fill the Gap Between Public and Private Coverage.
- Making Medicaid Work: Reforming Long-Term Care Systems.
- What if Medicaid Looked Like SCHIP? (Part I: Premiums and Cost-Sharing).
What if Medicaid Looked Like SCHIP? (Part II: Benefit Design).
AFTER THE GRANT
Staff at the National Academy for State Health Policy held a National Health Policy Forum session on the workgroup's recommendations in Washington in February 2005. They continue to present the recommendations to state and federal agencies, task forces and commissions addressing Medicaid reform, and to elected officials and Congressional health policy staff. The National Academy for State Health Policy's 2005 Annual Health Policy Conference, held in August 2005, dedicated five sessions to the final report and its recommendations; see the Bibliography for details.
GRANT DETAILS & CONTACT INFORMATION
Task Force to Make Medicaid Work in the 21st Century
Center for Health Policy Development/National Academy for State Health Policy (Portland, ME)
Dates: January 2004 to October 2004
Making Medicaid Work for the 21st Century Workgroup Members
Maryland Department of Budget & Management
Steve Berman, M.D.
Professor of Pediatrics and Director
Children's Outcomes Research Program
University of Colorado School of Medicine
State Affairs Coordinator
Barbara Coulter Edwards
Ohio Department of Job and Family Services
Schaller Anderson, Inc.
Senior Policy Analyst
Center for Public Policy Priorities
Massachusetts Department of Public Health
President and CEO
Hebrew Rehabilitation Center for Aged
Senior Vice-President, Business Development and Government Relations
Vice President, Business Development
Office of the Governor
Assistant Secretary, Aging and Disability Services Administration
Washington Department of Social and Health Services
Vermont Center for Independent Living
Institute for Health Care Policy and Research, Georgetown University
Bureau of Aging and Long Term Care Resources
Wisconsin Health and Family Services Department
Economic Social Research Institute
Oklahoma State Senate
Oklahoma City, Okla.
Michigan Department of Community Health
Robert Rubin, M.D.
Clinical Professor of Medicine
Executive Policy Advisor
Governor's Executive Policy Office
Centers for Medicaid and State Operations
Health Management Associates
Iowa State Senate
Des Moines, Iowa
National Academy for State Health Policy
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Improving Long-Term Services and Supports. Portland, ME: National Academy for State Health Policy, Issue Brief #5, December 2004. Also appears online.
Medicare and Medicaid Dual Eligibles. Portland, ME: National Academy for State Health Policy, Issue Brief #6, December 2004. Also appears online.
Options for Improving the FMAP formula. Portland, ME: National Academy for State Health Policy, November 2004. Also appears online.
Options for Improving Medicaid Eligibility. Portland, ME: National Academy for State Health Policy, Issue Brief, April 2004. Also appears online.
Options for Premium Assistance Programs. Portland, ME: National Academy for State Health Policy, Issue Brief #2, November 2004. Also appears online.
State Options to Control Costs. Portland, ME: National Academy for State Health Policy, Issue Brief #4, November 2004. Also appears online.
Smith V, Kaye N, Chang D, Bonney J, Milligan C, Milne D, Mollica R and Shirk C. Making Medicaid Work for the 21st Century: Improving Health and Long-Term Care Coverage for Low-Income Americans. Portland, ME: National Academy for State Health Policy, Issue Brief, January 2005. Also appears online.
World Wide Web Sites
www.nashp.org. "Making Medicaid Work for the 21st Century," on the National Academy for State Health Policy's Web site, includes an overview of the Making Medicaid Work for the 21st Century project and links to the Making Medicaid Work for the 21st Century Workgroup's full report, a summary of the report's recommendations, six issue briefs on key topics related to the report's recommendations and other related topics. Portland, ME: National Academy for State Health Policy, March 2004.
Presentations and Testimony
Alan Weil, "The Future of Medicaid: Strategies for Strengthening America's Vital Safety Net," testimony before the United States Senate Committee on Finance, June 15, 2005, Washington. Testimony appears online.
Report prepared by: Karyn Collins
Reviewed by: Kelsey Menehan
Reviewed by: Marian Bass
Program Officer: Pamela S. Dickson