Strategic Priorities For The Centers For Medicare And Medicaid Services To Advance Medicaid Reform

The PHE has made access to care and outcome disparities more visible. Compared to patients with Medicare and private insurance, patients on Medicaid have had less consistency (across states) in access to COVID-19 testing; treatments such as antibodies infusions; and less consistent access to new technologies such as remote patient monitoring, telemedicine, virtual diabetes care, and behavioral health that have been critical for individuals with chronic disease during the PHE. Although some states’ Medicaid programs are ahead of Medicare for telehealth and behavioral health.
The issues with chronic disease care in particular compound perennial limits on Medicaid recipients’ access to primary care. This is especially true when it comes to advanced “next-generation” primary care models (such as the ChenMed, Oak Street, Iora, and similar models) that require prospective payments, and specialty care. Access to similar Medicaid-focused programs such as CityBlock is not widespread. To address these troubling disparities for Medicaid patients, frequently driven by social risk factors, and close the gap relative to those covered by Medicare fee-for-service and Medicare Advantage, we believe it is critical to create attractive opportunities for innovation in Medicaid.
Fortunately, there is tremendous opportunity to improve the health and well-being of Medicaid beneficiaries while improving health care outcomes, equity, and the stability of state budgets. There are several reasons, described below, why CMS should be assertive in supporting greater Medicaid reform. What is more, the agency should not and cannot rely on its considerable efforts and experimentation in the Medicare program to improve care for Medicaid beneficiaries, close disparities, and catalyze systemwide changes for the entire nation.
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