Speak Out: Federal Proposal Would Weaken Access to Medicaid

/, Health care, Medicaid & CHIP/Speak Out: Federal Proposal Would Weaken Access to Medicaid

Current federal law requires states to ensure that Medicaid “services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area.” Now, the Trump administration has issued a proposed rule that would roll back current fee-for-service Medicaid access policies, allowing Texas and 16 other states with over 85% of their Medicaid participants in Managed Care to drop the fee-for-service monitoring and reporting standard, and also exempt them from monitoring the impact of fee-for-service provider rate cuts.

We’re concerned that this proposed rule change will be followed with even more attempts to weaken federal oversight of access to Medicaid, including for Medicaid Managed Care. Most advocates for Texas Medicaid participants and the providers who care for them would strenuously disagree that private contractors can consistently be relied on to act to protect the medical and functional needs of children, pregnant women, adults with disabilities, and seniors, and ongoing state and federal oversight is needed.

The 2015 rule now in effect requires state Medicaid programs to do periodic checks on specific Medicaid services. States have to report to Health and Human Services (HHS) every three years.

People with disabilities, medically fragile children, and elderly people who receive long-term services and supports from Medicaid waivers outside of a Medicaid Managed Care premium may be left with gaps in federal access oversight if this rule eliminates fee-for-service access oversight.

You can submit comments opposing this rule change by submitting comments on the proposal  by May 22, 2018 (the link to the proposed rule includes a green “Submit a formal comment” button).

The form to submit these comments will allow you to input simple comments in your own words, or to attach a document if you have longer comments.  Here are key issues you can consider including in your comment:

  • US HHS should not eliminate this oversight and monitoring of access to care in fee-for-service Medicaid. Instead, HHS should ensure that access to care every Medicaid beneficiary is equally protected regardless of whether they are served in fee-for-service, Medicaid Managed Care, or a Medicaid waiver;
  • The proposed rule would allow Texas Medicaid to make cuts of any size to fee-for-service Medicaid provider rates without detailed projections or tracking of impact, and fee-for-service rate cuts in Texas have historically been mirrored with Medicaid Managed Care premium cuts.
  • Texas Medicaid has experienced serious contractor failures and damaging provider rate cuts that reduce access to care, and the fact that we have outsourced care to Managed Care plans should not be used as justification to reduce oversight and monitoring;
  • I am/we are concerned about access to care for all Medicaid participants, and especially for people with disabilities, medically fragile children, pregnant mothers, and frail elders.

Learn more about the proposed rule, including links to background and sample comments here.

Anne Dunkelberg oversees health care policy for CPPP. She focuses on policy and budget issues related to health care access and immigrants’ access to public benefits. She joined the Center in 1994 from the State Medicaid Director’s Office at the Texas Health and Human Services Commission. Anne is a founding member of the statewide Children’s Health Coverage Coalition (formerly the Texas CHIP Coalition) and the Cover Texas Now Coalition. She has been recognized by Families USA as an outstanding Consumer Health Advocate and by the LBJ School of Public Affairs Alumni Association as a Distinguished Public Servant. She was the primary author of the first edition of Texas Medicaid in Perspective (“the Pink Book”) and serves on the Texas Medicaid Managed Care Statewide advisory committee and the Texas Healthcare Transformation Waiver Executive Waiver Committee. Anne is a native Texan, and received her B.A. from the University of Texas at Austin, and her M.P.A. from the LBJ School of Public Affairs at the University of Texas at Austin.

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