The Medicaid program is leading the way in many innovations in health care payment and delivery. Many of the dedicated advocates we work with are working to improve their state Medicaid programs, which is why I was excited to attend the release event for this year’s Kaiser Family Foundation annual Medicaid survey. This survey provides many useful insights and validation for why we at the Center push for high-quality, person-centered care for Medicaid beneficiaries, as well as innovative uses for Medicaid dollars. The release event focused attention on several of our key priorities, including health equity, social determinants of health and long-term services and supports.
The event presented the results of the survey with a panel discussion featuring the Washington, West Virginia and Tennessee state Medicaid directors, who provided updates on their work modifying their respective state Medicaid programs. On the health equity front, three states are seeking to expand coverage and improve the quality of care for postpartum people. Two-thirds of states reported new or expanded Medicaid initiatives to improve birth outcomes and/or reduce maternal mortality. Thirty-five states are leveraging managed care contracts to promote at least one strategy to address social determinants of health. All three state Medicaid directors who spoke at the event emphasized their efforts to coordinate care for justice-involved individuals prior to release.
In terms of long-term services and supports (LTSS) policies, about half of states raised wages for direct care workers in fiscal years 2019 and 2020. Fifteen states already have workforce development strategies in place for direct care workers. Of these fifteen states, ten states reported expanding workforce development strategies, with three states implementing new strategies. For Medicaid beneficiaries who utilize long-term services and supports, another important component of Medicaid is the Money Follows the Person program, which supports consumers transitioning from institutions back into the community. While states were able to get Money Follows the Person funding extended in the short-term, the future of this person-centered programming is not certain. These programs have been crucial to supporting the independence of people with disabilities, and Congress must continue to invest in these reforms.
The event highlighted the importance of consumer engagement in centering Medicaid innovation on the needs of beneficiaries. Gabe Roberts, the director of Tennessee Medicaid, touted the state’s relatively new Employment and Community First CHOICES program for those with intellectual and developmental disabilities, a program Community Catalyst consumer advocates [see our related blog and video]had a role in shaping to better fit the needs of consumers. He explicitly recognized the work of the consumer advocate community in building the Employment and Community First CHOICES program. 25% of Tennessee adults with intellectual and/or developmental disabilities are currently enrolled in the program, with a waitlist of 8,000 individuals.
While the focus on consumer advocates in Tennessee’s Medicaid reforms was exciting, the conversation surrounding Tennessee’s proposed Medicaid block grant was a good reminder of the importance of consumer advocates both in advancing positive innovations and blocking harmful policies. Block grants are harmful because they would result in Medicaid service cuts and threaten the coverage of tens of thousands Medicaid beneficiaries. When questioned about the proposed block granting of Tennessee Medicaid, the state’s director emphasized that the state was not intending to limit eligibility or benefits, yet the language of the waiver does not formally stipulate that eligibility requirements cannot be narrowed nor benefits decreased. The director’s response does little to address the harmful consequences of a Medicaid block grant.
What was striking was the variety of innovations different states are implementing. State Medicaid offices are taking advantage of new flexibilities and pursuing innovations that match the specific needs of their states. While these state initiatives are exciting, all progress must be centered on the lived experiences of beneficiaries, and consumer advocates must be involved in every step of the process. That’s why we continue to support state advocates on the front lines of ensuring consumer voices are involved in Medicaid innovation.