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Medicaid plans expect small budgets, more people


Nationwide, members are increasingly keeping their Medicaid coverage for a longer duration of time than has been typical in the past, and funding is thinner than ever.

For example, Louisiana's Medicaid enrollment jumped by more than 57,000 people while the budget for the fiscal year that started July 1 is down $300 million. This month, local providers will see an average 4.6% payment reduction.

Nationwide, members are increasingly keeping their Medicaid coverage for a longer duration of time than has been typical in the past, according to John Littel, EVP of Amerigroup. Littel is responsible for government affairs and corporate compliance for Amerigroup, a publicly traded company with more than 1.8 million Medicaid, CHIP, disabled and dual-eligibles in 11 states.

"The big issues are similar market to market, but each state approach is different," he says.


In light of fast approaching implementation deadlines for the Patient Protection and Affordable Care Act (PPACA), states will draft rules to satisfy the need for access, serving the underserved, quality and cost containment. Health plan leaders in the trenches can provide the front-line perspective that regulators lack. Don't miss out on the opportunity to be part of the collaborative process, however painstaking it might actually be.

"PPACA is a 2,700 to 3,000 page law that will result in up to a million pages of regulation," Littel says.

Beyond participation in regulatory processes, reinforce your own internal infrastructures-including clinical support and IT systems-so you're able to respond to unforeseen changes in the next decade.

"Many things will be enhanced and expedited because of the law," Littel says. "Make sure services such as case management are reflective of needs of the population and have measurements that demonstrate that. It was already important, but it's enhanced now because of the law."

Investment must be made in IT systems almost universally. Ideally, Medicaid plans will design platforms that deliver specific capabilities on a state-by-state basis. Data must also produce quality measurements in compliance with state mandates.

"You're taking care of a vulnerable population and doing it on behalf of the tax payers, so it's a fair thing to expect a heightened level of scrutiny," he says.

Among the questions that remain unanswered is how to anticipate the needs of incoming Medicaid members over the next decade. They could range from relatively healthy people who are simply accessing the healthcare system differently to those that have been uninsured and have significant, pent-up healthcare needs. Either way, preventive services will receive greater emphasis as plans try to keep members healthy and spending low.

Executives are also worried about what might happen to states' Federal Medical Assistance Percentage (FMAP), according to Littel. The nearly $87 billion increase in FMAP funding provided under the American Recovery and Reinvestment Act is set to expire on January 1.

Julie Miller is editor-in-chief of MANAGED HEALTHCARE EXECUTIVE. She can be reached at julie.miller@advanstar.com

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