CHIP Medicaid Public Policy

CMS’s Strategic Vision for Medicaid And CHIP

Where does the Centers for Medicare and Medicaid Services see Medicaid and the Children’s Health Insurance Program (CHIP) heading in the future. Based on a Health Affairs commentary from Brooks-LaSure and Tsai, the three key priority areas are (1) coverage and access, (2) equity, and (3) innovation and whole-person care. I review each of these approaches below.

1. Coverage and Access

Medicaid coverage is a difficult proposition.  At a federal level, CMS employees will want as many people who are eligible to be enrolled.  While this affects the federal budget, increasing the budget of the CMS departments increases their budgets and power withing the government.  While Medicaid is state and federally funded and partially federally regulated, States themselves may want to reduce Medicaid enrollment as this has a major impact on their budgets.  Not only that, 70% of Medicaid beneficiaries are covered by private plans that States pay to administer the benefit. For beneficiaries, many may want to get off of Medicaid since they may want to increase their income for other reasons, but doing so they may transition from Medicaid with limited cost sharing to ACA or private plans with more cost sharing. Nevertheless, CMS itself states that they are putting a priority on insuring those who are eligible are enrolled.  This is also complicated by some coverage provisions that occurred during the COVID-19 pandemic.

Between the onset of the public health emergency and May 2021, Medicaid and CHIP enrollment grew 15 percent, from 71 million to more than 82 million people, the largest increase over 18 months in the program’s history. This is in part due to Congressional action that ensured states would keep people with Medicaid enrolled for the duration of the public health emergency. Once this continuous coverage requirement ends, states will have 12 months to conduct eligibility renewals for everyone enrolled in Medicaid and CHIP; states must either renew enrollees’ Medicaid/CHIP coverage or connect them to low- or no-cost Marketplace coverage.

Wisely, CMS is trying to make it eaiser for eligible individuals to maintain coverage. However, States have mixed incentives regarding making maintaining coverage easier (better for beneficiaries) compared to making it more onerous (better for State budgets). 

“The period after the continuous coverage requirement ends is an opportunity to support states in developing long-term solutions to reduce administrative churn (where individuals lose their Medicaid coverage for administrative reasons, as opposed to being ineligible); examples include improving the use of administrative data for renewals (known as the ex parte renewal process) and eliminating onerous documentation requirements.”

Also, CMS is aiming to close the coverage gap that 4 million people face.  These are individual who earn too much to be Medicaid eligible, but do not qualify for ACA coverage. However, while CMS may pressure states to expand Medicaid, it is unclear if States will do this. There is $12.7 billion allocated to home and community based services (HCBS) from the American Rescue Plan to provide services for the aged and disabled who need additional care.  CMS is aiming to make sure these investments are made effectively.

2. Equity

CMS initiatives with respect to equity include: 

  1. Measure disparities in health care access, quality, experience and outcomes,
  2. Make evidence-based investments in equity-focused interventions, and
  3. Close or reduce those gaps in health equity, including by making funding and new federal investments linked to progress on reducing health disparities

Currently, most of the efforts focus around the measurement of disparities and it is not clear what specific initiatives around addressing health disparities will be enacted. 

3. Innovation And Whole-Person Care
According ot the article, whole person care relates to physical health, behavioral health, oral health, long-term care services, and social supports.  Wisely, CMS is focusing on insuring that behavioral health receives parity coverage with physical health.  As is the case for the CMS innovation center there is a focus on value-based care, where reimbursement is linked to quality. 

Background on Medicaid: 

Medicaid and CHIP provide essential health care coverage for over 80 million individuals and families, including low-income adults, over 40 percent of all children in the United States, older adults, and people with disabilities. Medicaid also covers 42 percent of all births in the nation. Two-thirds of these births are to Black, Hispanic, or American Indian/Alaskan Native people.

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