The ACA makes several changes to the Medicaid delivery and payment systems. These changes include:

  • Starting in 2014, States have the option to simplify their enrollment process and create a web portal for enrollment in Medicaid, Children’s Health Insurance Program, and federally subsidized plans. States can implement the on-line application system, the new data-based eligibility rules, renewal and verification process and states’ access to the federally managed data services hub (“the hub”), which will increase efficiency and lower ongoing administrative costs of enrollment in the long run. The hub service is free of charge for states.    
  • Starting in 2013 and 2014, States that choose to participate in the expansion and expand Medicaid eligibility for all adults to 133% of the federal poverty level receive full federal matching funds. These same States are also required to reimburse providers for Medicaid primary care services at 100% of the Medicare fee schedule amount.   
  • States may establish “health homes” for Medicaid enrollees with chronic conditions and elect the option by providing a 90% federal match rate for identified health home services for the first two years of a state’s operation of such programs.

Medicaid delivery and payment reform involves collaboration among federal agencies, including CMS and HHS, and state Medicaid agencies. To date, implementation of the ACA’s provisions on Medicaid delivery and payment include the following:

  • Regulations proposed and finalized in 2011 to provide guidance for implementing the relevant provisions of the ACA.
  • Regulations to promote Medicaid efficiency by minimizing procedural requirements for hospitals to participate in the Medicaid program.
  • Guidance from CMS to the States about the impact of the Supreme Court decision on the implementation of Medicaid expansion and on the payment structures to better incentivize higher-quality and lower-cost care.
  • Enhanced matching funds provided by CMS for health home care coordination services for those with chronic illnesses, a detailed tool to help support interested States in extending managed care arrangements to long-term services and support, and new templates to make it easier to submit section 1115 demonstrations.
  • Learning collaboratives, provided by CMS, with six states to contemplate improvements in value-based purchasing, data analytics, and other topics of key concern to states and stakeholders.
  • New initiatives to test innovative models of care relating to Medicaid populations, released by the Center for Medicare and Medicaid Innovation.

A one percentage point increase in the federal medical assistance percentage (FMAP), applied to expenditures for adult vaccines and clinical preventive services to States that cover, without cost-sharing, a full list of specified preventive services and adult vaccines.  The increase would apply to such expenditures whether the services are provided on a fee-for-service or managed care basis, or under a benchmark or benchmark-equivalent benefit package (referred to as an alternative plan).  In order for states to claim the one percentage point FMAP increases for these services, states much cover in their standard Medicaid benefit package all of the recommenced preventive services and adult vaccines, and their administration, and must not impose cost-sharing on such services.

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