Medicaid’s Strategic Vision for 2021 and Beyond — Reviewing CMS’s Latest Release

Last week, the two highest-ranking officials with oversight over the nation’s Medicaid program published a Health Affairs blog post outlining their strategic vision for Medicaid and the Children’s Health Insurance Program (CHIP). Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure and Center for Medicaid and CHIP Services (CMCS) Director Dan Tsai outlined “a new vision for Medicaid and what we plan to accomplish under the Biden-Harris Administration”, centered on three key areas of focus: (1) coverage and access, (2) equity, and (3) innovation and whole-person care.

Some quick takeaways: The blog post primarily highlights the importance of Medicaid and articulates the commitment of CMS, along with partner agencies, in coordinating and prioritizing the named focus areas. Specific initiatives or new investments are not outlined in the blog post. However, CMS is defining its vision and framework for what’s to come in the future.

CMS closes the blog post signaling an eagerness to ‘the road toward stronger, better Medicaid and CHIP programs’ — and many stakeholders are still eager to learn what programs, initiatives, and opportunities are ahead as part of this strategy.

The post outlines some key facts about the impact of Medicaid in 2021:

• Medicaid and CHIP cover more than 80 million beneficiaries — 20% of the U.S. population
• More than 40 percent of all children in the U.S are covered by Medicaid
• More than 42 percent of births are financed by Medicaid — and two-thirds of Medicaid births are born to Black, Hispanic, or American Indian/Alaskan Native people
• Medicaid is the largest payer for long-term services and supports, as well as public mental health services

The concepts outlined in the post tie back to the CMS Administrator’s strategic vision, released earlier this year, along with the CMS Innovation Center strategy refresh. Additional detail on the CMS Medicaid and CHIP focus areas is outlined below — while CMS references previous announcements and commitments to federal-state-stakeholder coordination, how this strategy plays out remains to be seen.

Focus Area 1: Coverage and Access: This focus area is the most comprehensive section of the CMS Medicaid vision. The agency outlines key strategies to ensure continued coverage and access for the program’s beneficiaries.

Medicaid enrollment has grown by 15 percent during the COVID-19 pandemic, and states have been relieved of the requirement to redetermine eligibility for Medicaid members. Once the public health emergency ends, many individuals may lose coverage — CMS pledges to work with states on keeping eligible beneficiaries covered through coordination with states, health plans, and stakeholders support the Medicaid renewal process, and connect individuals who may no longer be eligible to Marketplace coverage.

The agency also outlines a desire to partner with states who have not opted to expand Medicaid. This would extend coverage to the 4 million people in non-expansion states in the nation with incomes below 100% of the federal poverty level. Another key coverage and access focus is churn: in 2018 (pre-pandemic), 17% of people who lost Medicaid or CHIP coverage re-enrolled within three months. CMS pledges to work to improve eligibility and enrollment data collection and systems to ensure eligible people maintain Medicaid coverage.

The agency also outlines goals to expand access to home and community-based services (HCBS), building on investments made earlier this year, and to explore opportunities to create a “uniform minimum standard” for Medicaid policies for Medicaid and CHIP beneficiaries across the country.

Focus Area 2: Equity: CMS leadership has previously signaled that equity will be the first focus in new models and opportunities. In the blog post, equity is highlighted as a key focus — and closing identified disparities in quality, access and outcomes will remain a top priority.

Data on the race, ethnicity, language, disability status, and gender identity of beneficiaries are inconsistent, and CMS commits to work with states on “improving measurement of disparities across a core set of stratified metrics.”

Focus Area 3: Innovation and Whole-Person Care: CMS outlines a continued commitment to expanding value-based care in partnership with the Innovation Center at CMS and restates its goal to have most Medicaid beneficiaries (including dually eligible beneficiaries) in accountable care relationships by 2030.

An approach to whole-person care — ensuring a person’s physical health, behavioral health, oral health, long-term services and supports, and health-related social needs are taken into account — will be a focus of CMS in partnership with states and health care stakeholders.

A reference to Section 1115 demonstrations also signals a focus on value-based care, reduction of health disparities, and expansion of HCBS and behavioral health services — significantly different than the eligibility restrictions, work requirements, and capped financing priorities of the previous administration.

How can you learn more, or share your thoughts?

CMS has released a number of vision documents through press releases, blog posts, and white papers across its programs — as the organization outlines its vision and strategy, you can expect to see more information in the coming months.

CMS has undertaken a stakeholder engagement effort to inform its approach, and credits discussions to date as the inspiration for these areas of focus. The opportunity to provide comment on Medicaid priorities will continue over the next several months through CMS’s Innovation Center strategic refresh effort (my takeaways from that release are available here.) Additional detail on the nation’s Medicaid and CHIP program can be found at medicaid.gov.

To learn more, watch this space — I’ll be keeping my eye on CMS updates and sharing my thoughts here. In the meantime, if you have specific questions, areas you’d like to learn more about or want to share your own take on the vision for Medicaid, I’d love to hear from you — you can get in touch at kalin.scott@hsg.global or @kalinscot on Twitter.