What’s on the Mind of Margaret “Meg” Murray of the Association for Community Affiliated Plans?


Our guest on this month’s episode of the “What's on Your Mind” podcast is Margaret Murray, M.P.A., founding CEO of the Association for Community Affiliated Plans (ACAP) and a longtime member of Managed Healthcare Executive® editorial advisory board. Murray is an expert on Medicaid and healthcare policies that affect people with low incomes. In the interview with Managing Editor of MHE, Peter Wehrwein, she discusses ACAP’s growth and its legislative wins, Medicaid redetermination, “junk insurance,” and state Medicaid programs carving out pharmacy benefits.

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Here are few excerpts from the transcript of their conversation. They have been edited for clarity and length.

I am interested getting you to reflect a little bit about the fact that we are a quarter of the way, roughly, into the 21st century. Pulling back a little bit, what is on your mind, what are the challenges for your organization and your members?

Because of the pandemic, ACAP (Association of Community Affiliated Plans) was not able to officially celebrate its 20th anniversary, but we were founded on the first year of the century, in 2001. So we are now at year 22. But we are thinking ahead to our 25th anniversary, so we've definitely been thinking about what ACAP has accomplished over the last 22 plus years.

We started off as a trade association for 17 Community Health Center plans. Now we're up to 68 what we call safety net plans. And over that time period, we've had a couple of major congressional wins that have affected the whole Medicaid industry and Medicaid managed care industry, starting with the inclusion of the Drug Rebate Equalization Act in the Affordable Care Act. That was really our first big legislative win. It enabled the states to get drug rebates for people that were in Medicaid managed care plans. It resulted in many states deciding to carve drug (coverage) into managed care, as opposed to carving it out, to get the rebate, and had a benefit for beneficiaries because then the health plan really had control over the whole person care.

Are your members concerned about the end of continuous enrollment and redetermination — deciding whether people are in fact eligible for benefits.

It will be a big challenge. It was really one of the smartest things that the Congress did way back in 2020, in one of those first bills, where they said to states that if you want the enhanced financial support, states had to agree to keep people on Medicaid and not be redetermined (for eligibility). Some people have been on now for two and a half years. Medicaid has grown tremendously. There's 90 million people on Medicaid.

But, yes, states could start as of Feb. 1 to do outreach to people to tell them that they need to certify that they are still eligible for Medicaid. April 1 is when some people might lose eligibility.

The plans and the states are working very closely together, along with CMS. Plans are being very creative in reaching out to people to remind them they need to update their addresses and reminding them that redetermination is coming up.

One of the things we want to make sure about is that there's not a bolus of people that are redetermined at one point in the beginning of ’23. Because then every year you'll have this big number of people in the early part of the year that are being redetermined. Plans want to make sure that the people are being redetermined throughout the year.

We've done a lot of stories out Inflation Reduction Act and its healthcare provisions. Are there some healthcare provisions of the Inflation Reduction Act that are going to affect your organization and your members and ultimately Medicaid beneficiaries?

One of the big provisions in the inflation Reduction Act extended what we call the enhanced advanced premium tax credits (for the marketplace plans). During COVID, the federal government increased the subsidies for people who are on the marketplace plans. And they were going to go away this year. Our members had been up in Congress — or at least virtually meeting people from Congress — to say we really need to make sure that those enhanced premium tax credits are extended. They were, although unfortunately only for three years; we were hoping to make them permanent. But it will ensure that nobody pays more than I think it's 8.5% of their income for healthcare.

How have high drug prices affected your members and the services that they can offer the beneficiaries?

We don't typically work on state level issues. But California recently did carve out drug coverage out of the capitation and New York is in the process of doing so. Our plans have fought hard against that. There is a lot of concern that the states are looking at the rebates. We have funded studies showing it still will cost states more to carve the drugs out; unfortunately, there are dueling actuaries. We'll need to see what the results are in California. It's only been in place, I think, for maybe a year now.

We don't think it's good financially. But, more importantly, we don't think it's good for the beneficiary — it's better when the health plan is responsible for as much of the whole person's care as they can be.

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