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 CMS Proposal Gives States a Path to Medicaid Managed Care

A new proposed rule published March 22 by the Centers for Medicare & Medicaid Services (CMS) would give states a break from some regulations as they relate to managed care plan offerings for Medicaid. The draft rule is in line with some recommendations made recently by the Medicaid and CHIP Payment and Access Commission (MACPAC) to promote managed Medicaid over fee-for-service (FFS) programs.

The CMS proposal would give states exemptions from rules mandating that they analyze data and monitor access to FFS plans when the large majority of their Medicaid recipients get their insurance via private managed care insurers. In a broader measure, the rule gives all states, not just managed care-majority states.

Just last week, MACPAC in its March Report to Congress pushed for more efficiencies in helping states move to managed care plans for Medicaid. In the report, the commission noted 80 percent of Medicaid beneficiaries—even those with complex health needs—receive health care through some type of managed care.

States, they said, can operate managed care using three separate legal authorities under the Social Security Act: waiver authority in Sections 1115 and 1915(b) and state plan authority in Section 1932.

To help reduce the administrative burden for states to implement managed care programs without compromising beneficiary protections, MACPAC wants Congress to amend Section 1932(a)(2) to allow states to require all beneficiaries to enroll in Medicaid managed care programs under state plan authority, to extend approval and renewal periods for all Section 1915(b) waivers from two to five years, and to revise Section 1915(c) waiver authority to permit Section 1915(c) waivers to waive freedom of choice and selective contracting.

“Allowing states to have a more streamlined mechanism to select managed care as their delivery system and requiring beneficiaries to enroll in such systems is appropriate at this time,” according to the commission. MACPAC backs this policy because it offers a strong regulatory framework for beneficiary protection and oversight, a large number of beneficiaries are already enrolled in managed care, and there is clear value in managed care’s ability to coordinate care at a time the states and federal government are looking to conserve resources.

Read all of the recommendations at

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