The proposed changes to Medicaid/CHIP recently released by CMS are intended to “let states focus more on delivering quality health care to their beneficiaries.” These changes will not achieve this goal, and they come at the cost of undermining protections for Medicaid beneficiaries, who are the most vulnerable in our population.
First, these changes are designed to encourage states to move from traditional fee-for-service Medicaid to managed care programs provided by private health insurers. The problem with Medicaid managed care plans is that, in fact, they are less efficient, more expensive and deliver poorer outcomes compared with traditional Medicaid. If Ms. Verma seeks to help states deliver quality care, she would be wise to stop encouraging privatization of Medicaid.
Second, these changes will eliminate time/distance standards for provider networks, which limit how far an enrollee must travel to see a provider and are used to measure network adequacy. Elimination of these standards will narrow Medicaid managed care networks further; while telemedicine may be an innovative solution to this problem, why must it come at the expense of the standards as currently written?
Finally, by relaxing standards for how states determine actuarial soundness, they will effectively lower the actuarial value of Medicaid plans, which will mean a race to the bottom: as the actuarial value of these plans drop, they will cover fewer services, thereby reducing care for our most vulnerable.
In sum, clinicians can expect that the care of our Medicaid/CHIP patients will suffer as a result of these changes.
Philip A. Verhoef, PhD, MD, FAAP, FACP
Assistant Professor of Medicine and Pediatrics
Department of Medicine
University of Chicago
Disclosures: Verhoef reports no relevant financial disclosures.