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CMS to States: We Want to Help You Transform Medicaid

At the C-TAC/ Harvard Petrie-Flom event on April 27, Medicaid Chief Medical Officer (CMO) Aditi Mallick, MD, declared unequivocally the desire of CMS to work with states in transforming Medicaid into a more community-based benefit. She articulated the three policy priorities for CMS—Coverage & Access, Equity, and Whole Person Innovation—and stated that they all point to more Home and Community-Based Services (HCBS). Dr. Mallick discussed the CMS goal to create broader access to HCBS; to include health-related social needs, and to introduce system reforms to achieve Value-Based Serious Illness Care.

Dr. Mallick’s comments set the stage for an in-depth discussion among the leading experts currently working to establish Community Palliative Care Benefits for Seriously Ill persons in Medicaid. Key topics addressed included balancing the tension between establishing best practices applicable to all states; and allowing flexibility for a state to account for geographic and cultural disparities in order to tailor the benefit and maximize the likelihood of success. Dr. Mallick acknowledged the balancing of both considerations.

Several speakers discussed California’s and Hawaii’s efforts, and the challenges they faced, with advice for states considering action. A number of other states are considering developing a Palliative Care Benefit either as a stand-alone new benefit or layering on to existing programs.

The experts discussed communication, public and provider education/buy-in needs and methods, the challenge in defining a benefit and the universe of recipients, and the evidence of cost savings.

CMS is investing in these opportunities in several ways:

  • American Rescue Plan Act (ARPA) gave a 10% increase to states which applied to address issues such as workforce and constraints in access. Medicaid.gov has a one-stop-shop to access all state’s plans (Sec 9817).
  • A new Money Follows the Person (MFP) request for proposals is open until Mid-May for states recruiting partnerships and providers to support transitions to the community.
  • And, per Dr. Mallick, there is much opportunity through Medicaid authorities such as 1115, State Plan Amendments (SPA), and waivers.

The significant takeaways from the session:

  • Stakeholder buy-in is a critical first step and it takes time and much outreach;
  • Philanthropy has been instrumental in supporting start-up infrastructure;
  • The definitions of the benefit and who receives it, and provider standards are critical issues still being worked out—especially what is standard across states and what is flexible
  • There is ample evidence of cost savings. Even at the lowest end data shows cost-neutral and many studies show significant savings.

Why is this important?

It shows the viability of this work and affirms that federal partners are eager to help states develop these benefits. As one panelist said: There is no reason to avoid doing this.

Now is the time. As never before, the circumstances are ripe for C-TAC members to work in partnership with state coalitions and others to achieve a key objective of expanded Medicare and Medicaid funding for community-based services, especially for those most in need. 

The full session will be posted in the next few weeks and will be linked on the C-TAC site. It is well worth your time to listen and consider this rich discussion and how you can participate.

In addition to Dr. Mallick, we thank our expert panelists: Anastasia Dodson, Wendy Fox-Grage, Kathleen Kerr, Rae Seitz, Allison Silvers, Elrycc Berkman, Hope Glassberg, Zirui Song, and Torrie Fields for their invaluable contributions to this program and this work.

Written by Cheryl Matheis | C-TAC Strategic Advisor