Five Things I Learned about Medicaid from Cindy Mann
Fri, Dec 15, 2017 -
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Deanna Moore
On Thursday. Dec. 7, I had the opportunity to attend Grand Rounds at University Hospitals Rainbow Babies and Children’s Hospital and hear a presentation from former director of the Centers for Medicare and Medicaid Services, Cindy Mann. This was not the first time I’d had the opportunity to hear her speak and was delighted to be invited since I love learning about health policy from those who have shaped it personally. There is so much policy in play right now that would impact healthcare, I was eager to hear her thoughts about it – and she didn’t disappoint. Here are my top five takeaways from Mann’s presentation.
1. Medicaid per capita spending is growing slower than Medicare and private insurance.
With the constant talk of reigning in out-of-control healthcare spending and the cost-control tasers aimed squarely at Medicaid, I would not have guessed this. Interestingly, Mann added that the growth that has been seen in Medicaid spending has been primarily due to adding new population – not profligate spending or fraud.
2. When the program began, Medicaid was an adjunct of the welfare program.
In Medicaid’s early days, people who received welfare benefits – at that time known as Aid to Families with Dependent Children or AFDC – were automatically enrolled in Medicaid. The two programs were seen as being intertwined. In 1996 when AFDC was transitioned to the Temporary Assistance for Needy Families block grant program, eligibility for Medicaid was separated from welfare; however, the initial linkage of the two programs has shaped Medicaid’s perception in Congress, according to Mann. Today, Medicaid is a broad-based insurance program, available to all people at 138 percent of the federal poverty level (that is, if they’re lucky enough to live in a state that expanded Medicaid like Ohio).
3. Given the current political climate, state Medicaid waivers seeking to curb enrollment may be approved by CMS; however, they will almost certainly face legal challenges.
Mann says this is because waivers that do not meet the goals of the Medicaid waiver program – one of which is improving access to care – are subject to legal challenges. Ohio’s Biennial State Budget for 2018-2019 included a provision requiring the Ohio Department of Medicaid to submit a waiver to CMS that, if approved, would require Ohio Medicaid beneficiaries to pay premiums to access the program, including those only 1 percent above the poverty line. Even though the premiums would be small, there is strong evidence that cost-sharing of any amount deters lower-income people from accessing care. , a situation that clearly does not improve access to care and one that could very well prompt legal challenges.
So how likely is it that we will see a Medicaid waiver sent to CMS? Fairly likely, actually. Governor Kasich vetoed the waiver line item in the budget, but the House overrode his veto. The Senate, which hasn’t voted on this yet, could still act on it at any time before the end of the biennial budget, triggering ODM to send a waiver request to CMS.
4. Our voices matter.
I was touched by the heartfelt thank you Cindy Mann expressed to the providers in the audience and others throughout the country that advocated for Medicaid on behalf of their patients. “I am in awe of people around the country who reached out and advocated for patients,” she said. “I don’t think anyone would have believed that we wouldn’t have Medicaid caps or work requirements by the end of 2017.”
Mann stressed that physicians can make a real difference in the future of the program by reaching out to their legislators and expressing how important Medicaid is to their patients. Including personal examples and outlining the specific consequences you would expect from a provider standpoint (e.g., people will use the emergency room for care instead of getting the right care at the right time in the right setting) is especially effective.
5. We should be proud of how strong our Medicaid safety net is in Ohio.
This notion is not new to me. I’ve been advocating for Medicaid policy that ensures access to those who need it for much of my career; however, there was something very hopeful about Mann’s portrayal of the Medicaid program that I think I sometimes forget. Medicaid is incalculably beneficial to those who need it and our goal should be to ensure our safety net is as broad and strong as possible. When more people enroll in Ohio’s Medicaid program and there is a corresponding increase in spending, that is a good thing because it means more people are able to access the care they need. I’m not saying we shouldn’t be good stewards of our tax dollars and look for ways to promote efficiency, but the ever-vigilant, laser-beam focus on cost belies what that spending means to the most vulnerable residents of our state.