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New Flexibility for States to Improve Medicaid and Implement
Innovative Practices Announced
New rules will make Medicaid more flexible and efficient,
helping states provide better care and lower costs
The U.S. Department of Health and Human Services (HHS) announced
four initiatives to give states more flexibility to adopt innovative
new practices and provide better, more coordinated care for people
with Medicaid and Medicare while helping reduce costs for states and
families. The initiatives support the Obama administration’s work to
make Medicaid more flexible and efficient and to address long-term
cost growth. Several of the announcements also help implement
provisions of the Affordable Care Act. Today HHS announced:
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Fifteen states will receive federal funding to develop better ways
to coordinate care for people with Medicare and Medicaid coverage,
also known as dual eligibles, who often have complex and costly
health care needs.
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All states will receive increased flexibility to provide home and
community-based services for more people living with disabilities.
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All states are eligible to receive more money to develop simpler and
more efficient information technology (IT) systems to modernize
Medicaid enrollment.
- A proposal by the state of New Jersey for flexibility to expand
health coverage for nearly 70,000 low-income residents has been
approved.
“Medicaid programs provide health coverage for millions of
low-income Americans who otherwise would lack access to health
care,” said HHS Secretary Kathleen Sebelius. “With these new
resources and flexibilities, states will have new options to make
their Medicaid programs work better for the people they serve, while
helping lower their costs.”
Coordinated Care for People with Medicare and Medicaid
Under a new initiative funded by the Affordable Care Act, 15 states
will receive up to $1 million each to develop new ways to meet the
often complex and costly medical needs of the approximately nine
million Americans who are eligible for both the Medicare and
Medicaid programs, known as “dual eligibles.” The goal of the
program is to eliminate duplication of services for these patients,
expand access to needed care and improve the lives of dual eligibles,
while lowering costs. The new Federal Coordinated Health Care
Office, or the Duels Office, at the Centers for Medicare & Medicaid
Services (CMS), was created by the Affordable Care Act to improve
care for dual eligibles and will work with the states to implement
the top strategies to coordinate primary, acute, behavioral and
long-term supports and services for dual eligibles, improving
quality and lowering costs.
The 15 states that will receive these funds are California,
Colorado, Connecticut, Massachusetts, Michigan, Minnesota, New York,
North Carolina, Oklahoma, Oregon, South Carolina, Tennessee,
Vermont, Washington and Wisconsin.
“Beneficiaries who are in both Medicare and Medicaid can face
different benefit plans, different rules for how to get those
benefits and potential conflicts in care plans among providers who
do not coordinate with each other,” said Donald M. Berwick, M.D.,
administrator of CMS. “This can be disastrous for those
beneficiaries who are most vulnerable and in need of help.”
Helping People with Disabilities Live in their Communities
CMS proposed new rules today giving states new flexibility for their
programs to help people with disabilities choose to live in their
communities rather than in institutions. The proposed rules reduce
administrative barriers for states seeking to help multiple
populations, which may include seniors and/or people with different
types of disabilities. They will also allow individuals to
participate in the design of their own array of services and
supports, including such things as personal care and respite
services for caregivers.
“These long awaited rules will help people living with disabilities
realize the promise of the ADA to live in the least restrictive
environments possible for them—like their own homes,” said Henry
Claypool, director of the Office on Disability at HHS. “With these
new tools as well as incentives included in the Affordable Care Act,
states, working closely with advocacy groups, beneficiaries, and
other stakeholders, can more easily develop effective plans to
improve options for people with disabilities. We hope states will
take advantage of this new flexibility.”
The proposed rule, CMS-2296-P, can be found at
www.ofr.gov/inspection.aspx.
Developing and Upgrading Medicaid IT Enrollment Systems
New rules issued today will provide 90-percent of the cost for
states to develop and upgrade their IT systems to help people enroll
in Medicaid or the Children’s Health Insurance Program (CHIP) – and
75-percent of ongoing operational costs. This increase over the
previous federal matching rate of 50-percent will help states
prepare for the Medicaid improvements and expansion that will come
in 2014 from the Affordable Care Act, when many more Americans will
be eligible for these programs, and to coordinate enrollment with
the Exchanges. The rules establish performance standards for the
improved eligibility systems to promote greater efficiency and a
more consumer-friendly enrollment process.
The final regulation, CMS-2346-F, can be found at
www.ofr.gov/inspection.aspx.
Expanding Health Coverage in New Jersey
HHS Secretary Kathleen Sebelius today approved a Section 1115
demonstration for New Jersey that will expand health coverage to
nearly 70,000 uninsured, low-income people through the Work First
New Jersey program. In addition, the state will increase care
coordination to improve health outcomes for participants in the
program.
“This demonstration is yet another example of the many flexibilities
states have to adapt their Medicaid programs to better serve their
residents,” said Secretary Sebelius. “I want to commend New Jersey
for expanding coverage to people in need.”
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