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Medicaid adviser supports improving access to integrated care models

A congressional Medicaid adviser approved recommendations meant to increase access and enrollment in integrated models of care for the Medicare and Medicaid programs.

During an April 2 meeting, the Medicaid and CHIP Payment and Access Commission, or MACPAC, passed two recommendations for its June report to Congress that were aimed at integrated care for dual-eligible beneficiaries, who may sign up for both Medicaid and Medicare coverage.

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Medicaid is the state and federally run health insurance program for people with low incomes, a large population that includes children and seniors. Americans age 65 and older are covered by the Medicare insurance program.

MACPAC makes policy recommendations to Congress regarding the Medicaid program through March and June reports. The commission does not have legislative authority.

Integrated care models combine Medicare and Medicaid benefits into one treatment model rather than requiring beneficiaries to use each program separately. Integrated care models can allow for more efficient and better care for beneficiaries, according to the commission.

About 1 million dually eligible beneficiaries are currently enrolled in the models, which is less than 10% of those eligible, according to data presented by MACPAC.

The first recommendation asks for the U.S. Centers for Medicare and Medicaid Services to allow dual-eligible beneficiaries to enroll in integrated plans on a monthly basis. The second recommendation is for Congress to approve additional funding to help states increase their expertise in Medicare and implement integrated care models.

MACPAC analysts said the recommendations are part of a multiyear plan to boost access to integrated care.

The commission agreed on a recommendation to improve coordination between states' Medicaid programs and Tricare, the health insurance program for the U.S. Department of Defense. The commission also agreed on a recommendation to ensure that costs are not being shifted unnecessarily from Tricare to Medicaid.

Impact of coronavirus pandemic

While the work for the recommendations started before the coronavirus pandemic, the outbreak's impact on the U.S. loomed over the meeting.

Multiple commissioners stressed that recommendations like supporting integrated care models will be needed even more so in the context of the pandemic.

Melanie Bella, MACPAC's chairman, said it is important to monitor the changes being made by the federal government and state governments in their responses to the outbreak. Bella said the commission's goal is not to police changes, but to ensure transparency while programs are being adapted.

The CMS is allowing broad changes to Medicaid through what are called section 1135 waivers, which enable the agency to alter the rules of Medicare, Medicaid and the Children's Health Insurance Program when a national emergency has been declared.

The agency so far has relaxed enrollment requirements for providers that want to join a state's Medicaid program and eased prior authorization requirements, among other changes.

CMS Administrator Seema Verma announced April 2 via Twitter the approval of four more section 1135 waivers, bringing the total number of states to gain waiver approval to 44.

Bella said while the federal government is approving waivers, it is important to make sure that states are not getting reasonable requests denied.

Charles Milligan, vice chairman of the commission, said changes being made at the state level, like opening up telehealth Medicaid policies and changes in section 1135 waivers, should be monitored to see if they improve access and could become permanent parts of the program.