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The Center for Medicare and Medicaid is an important stakeholder in achieving our 2025 goal of ensuring that those programs adopt our Core Principles to support the patient and unpaid caregiver throughout the serious illness journey. At our recent Summit we featured a promising Medicaid palliative care benefit from Hawaii and the new strategies below give us additional avenues to help spread it and other serious illness resources. A recent Health Affairs blog on Medicaid’s new strategic direction point to additional opportunities for improving care for the serious illness population. As with the new strategy for CMMI, many of the new Medicaid strategies align with C-TAC’s priorities, including our Core Principles for Care Models, which we will reinforce in our continued engagement with CMS.
Key Medicaid Strategy Elements:
- Innovation and whole-person care. Most encouragingly, Medicaid will continue to encourage innovation in value-based care, delivery system reforms and whole-person care. These are C-TAC’s key policy priorities as well and are reflected in our core principles, see below. Medicaid’s approach includes partnering with states to ensure the health care system considers and supports the whole of a person’s needs: physical health, behavioral health, oral health, long-term service and supports, and health-related social needs. C-TAC looks forward to being a partner with Medicaid in advocating for both innovative and whole-person care.
- Broaden access to home and community-based services (HCBS). C-TAC recognizes that these services give older adults and people with disabilities the choice to stay in their homes and communities while receiving critical health, functional and social supports. Medicaid will continue to work with Congress and other federal partners to advance HCBS improvement and reform and to make continued investments in this area and C-TAC will continue to reinforce those efforts through our advocacy work.
- Address equity and reduce disparities. C-TAC and Medicaid are both dedicated to measuring disparities and making targeted, evidence-based efforts to improve health equity. C-TAC supports Medicaid’s plan to advance health equity by:
- Measuring disparities in health care access, quality, experience, and outcomes
- Making evidence-based investments in equity-focused interventions
- Closing or reducing those gaps in health equity, including by making funding and new federal investments linked to progress on reducing health disparities.
- Establish section 1115 waiver policy principles and criteria. Section 1115 of the Social Security Act authorizes the Secretary to approve experimental, pilot, or demonstration projects that are likely to promote the objectives of Medicaid. C-TAC has worked with several states developing waiver applications to mandate benefits such as community-based palliative care. Having a clear set of 1115 demonstration policy principles will help ensure that federal Medicaid policies support equity and financial stewardship consistently across states and will also enable states to formulate and share their waiver plans to improve the care for serious illness with each other.
- Protect access to coverage after the covid-19 continuous coverage requirement ends. The pandemic has expanded the population of those living with serious illness and has disproportionately affected communities of color. The new Medicaid strategy is highly focused on making sure eligible people maintain coverage after the COVID-19 public health emergency ends. At that point states will have 12 months to conduct eligibility renewals for everyone enrolled in Medicaid and we are hopeful that some will consider expanding Medicaid permanently which would especially help those with serious illness. C-TAC again appreciates that Medicaid is committed to engaging stakeholders (including local community-based organizations, enrollment assisters, health centers and others) on an ongoing basis so that individuals enrolled in Medicaid have support to complete the renewal process, and working across CMS to improve transitions for people no longer eligible for Medicaid to subsidized Marketplace coverage.
C-TAC appreciates that Medicaid acknowledges the best ideas and approaches for how to tackle health disparities will come from voices and stakeholders on the ground. Many of C-TAC’s members have the expertise to help them do so and C-TAC will advocate and facilitate interactions with these important community partners.
Medicaid and CHIP provide essential health care coverage for over 80 million individuals and families, including low-income adults, older adults, and people with disabilities. In addition to providing coverage of physical health care, Medicaid is the largest payer for long term services and supports, including home and community-based services (HCBS), which allow individuals with a range of disabilities and needs to thrive and live independently at home or in their communities.
Click here to view C-TAC’s Core Principles for Models with Serious Illness Populations
Written by: Marian Grant, C-TAC Senior Regulatory Advisor