Medicaid payment rates are holding firm, according to a survey of Medicaid directors from each state and the District of Columbia released Oct. 15 by the Kaiser Family Foundation.
“No states are now making across-the-board budget-driven cuts to Medicaid provider rates in fiscal 2016, something which we quite commonly saw only a few years ago during the economic downturn,” Vern Smith, Ph.D., managing principal of Health Management Associates, said during a press briefing on the survey.
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Dr. Smith noted that the rate increases and decreases that are occurring are “routine and targeted in nature.”
State Medicaid programs are increasing benefits as well. “Last year, just one state limited their benefit,” and it was utilization controls applied to those who qualified for expanded Medicaid access, Dr. Smith said. For fiscal 2016, five states reported benefit restrictions. “On the other hand, over half of the states, a total of 28, expanded benefits in some way, with 24 states expanding or enhancing benefit offerings in 2015, and 18 states adopting benefit expansions/enhancements for fiscal 2016.
“The most common benefit expansion … was for behavioral health services,” Dr. Smith said. “The second most common was for long-term care service.” Other areas that had expansion of benefits were in dental services and telemedicine.
Concerns for state Medicaid programs also were identified in the survey, specifically regarding Medicaid expansion under the Affordable Care Act and cost control.
“The focus on ensuring the greatest possible value for state tax payers is always a top priority,” Dr. Smith said. “Many directors in this area specifically singled out their priority on controlling the escalating cost of specialty drugs.”
Other priorities included delivery system and payment reform initiatives and a greater focus on the social determinants of health and population health, two terms Dr. Smith described as being something new in the vocabulary of Medicaid.
“State Medicaid programs are focused on performance, value, and improving health in a way never seen before in the 50-year history of the program,” he said.
The stability of benefits and payment rates comes as Medicaid is seeing its greatest increases in enrollment and state government spending, primarily driven by the ACA. Currently, 30 states and the District of Columbia have expanded their Medicaid eligibility.