Medicaid is now the largest coverage
program in the nation, consuming over a quarter of state budgets, and that
share is rising at an unsustainable rate. State Medicaid programs are working
on reforms to shift from a system that rewards volume with no regard to quality
to a better system that builds value. Next week in Boston the Council of
State Governments-Eastern Region is hosting State
Medicaid Reforms: Different Models, Common Goals, a meeting of
Northeastern state Medicaid policymakers, including several from CT, to learn about best practices across the
US, available support and to share resources. CSG-ERC has posted three
backgrounders to support the meeting. The first describes
state reform models and the second outlines the
status of Medicaid reforms in ERC states including CT.
Focusing on work done in CT, the third brief gives states options
to prevent inappropriate underservice. As an income-based,
entitlement program run by states with federal support that serves members at
risk for poor health due to social determinants, Medicaid carries both unique
strengths and challenges. Unnecessary over-treatment has received a great deal
of attention as a driver of rising health costs in the wider health care
system, but inappropriate under-service is also a problem across payer sources.
As health care payment moves away from volume-based systems such as
fee-for-service to quality and risk based systems such as shared savings, the
potential for underservice grows. Federal regulations acknowledge, “Programs
that include incentives to reduce costs for care may result in unintended
consequences such as avoidance of at-risk patients, [and] “stinting” on care”. The meeting will be at the
Massachusetts State House June 29th from 10am to 4pm. Click here for
more
info and registration.
