July 30th marks an historic day—the 50th Anniversary of Medicaid (and Medicare). With Medicare in the traditional “big brother” role, Medicaid often gets forgotten. But this year, with King v Burwell no longer in the crosshairs, and a major revamp of the Medicare payment system in recent history, Medicaid is standing front and center. No matter your political leanings or point of view, this is probably both a good thing and a bad thing; it is an opportunity to both celebrate and potentially change the program.
For health centers, of course, Medicaid represents their single largest payer source and a lifeline for many health center patients. It doesn’t mean the program is perfect, but it is a recognition of the important role it plays for millions of Americans. Accordingly, NACHC, as the founder and Chair Emeritus of the Partnership for Medicaid, is participating in a media campaign to celebrate Medicaid’s upcoming “Golden” Anniversary! Please stay tuned for more on that over the coming month….
Medicaid on the Hill…
In the meantime, Capitol Hill is also gearing up for potential changes and tweaks to the program in its 50th year. In fact, the House Committee on Energy and Commerce recently held two separate hearings on the Medicaid program. The first was entitled, “Examining the Administrations Approval of Medicaid Demonstration Projects,” held on June 24th, and the second was entitled “Medicaid at 50: Strengthening and Sustaining the Program,” and was held on July 8th.
While there is no longer the same sort of impetus for major Medicaid changes as there would have been if the ACA was overturned by the SCOTUS in King v Burwell, Budget Reconciliation remains a potential vehicle for additional health care changes this year—and Medicaid could well be a part of that. Accordingly, we are looking to these recent hearings as a clue for what direction the Congressional Majority might go.
First up is a focus on waivers. Questions have been raised about Medicaid 1115 waivers from almost every possible angle—from whether there ought to be more Federal oversight, to whether such waivers are truly furthering projects that the Federal government wants to promote, to whether they are truly budget neutral (and how that is determined) to how to streamline the waiver process so that once a waiver is approved in any state, it may be automatically picked up by another state. There are no definitive answers to any of these questions, but it is worth knowing that these are all areas that may be further explored in the coming months.
Another area of discussion is around financing—the counter-cyclical nature of the Medicaid program in times of economic downturn, as well as the federal-state match, and innovative ways states draw down the federal match—including intergovernmental transfers (IGT) and provider taxes. While those items have limited impact on FQHCs, it is not unheard of for some states to impose provider taxes on FQHCs for purposes of putting forward the state match, so it is something we will watch closely.
A Health Center Mention!
Last but not least, the most important moment of the hearings was a question asked by Energy and Commerce Health Subcommittee Ranking Member Gene Green of Vikki Wachino, Deputy Administrator of CMS and Director of the Center for Medicaid and CHIP Services. Ms. Wachino’s remarks can be seen here at the 36:15 mark. Representative Green asked about the unique role and intertwined nature of FQHCs and Medicaid, and Ms. Wachino responded by saying that:
“Community [health] centers play a really vital role in serving our populations and meeting the needs of a diverse range of Americans, particularly focused on primary care. CHCs are playing a growing role in meeting low-income Americans oral health care needs, which are important to us. And we continue to work with them to make their payment systems as strong as possible.” We are lucky to have such a strong supporter in Ms. Wachino and we look forward to her continued leadership at CMS!
Please stay tuned to the blog for updates as we approach Medicaid’s 50th Anniversary at the end of the month!