Friday Five: Medicaid transformation plans and the potential impact to states
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In this week’s Friday Five, MAXIMUS is reading about Medicaid transformation efforts including a state data-sharing project, CMS audits to address fraud and waste, and government reorganization plans aimed at consolidating and modernizing programs.
Eight states were selected by the National Governors Association to share best practices, data, and analytics in an effort funded by the Robert Wood Johnson Foundation. According to Health IT Analytics, the 16-month project is designed to encourage Medicaid innovation, while also reducing costs and improving value. Two additional groups of states are working on similar complementary projects.
This week, the Centers for Medicare and Medicaid Services (CMS) announced they will begin auditing state Medicaid eligibility tiers and medical loss ratio accuracy this summer. In addition, Fierce Healthcare reports CMS plans to audit reported medical costs versus spending from private Medicaid managed care plans. The audits will help determine if states are receiving the proper amount of federal funding.
Modern Healthcare also reports on the upcoming CMS audits, which are part of a larger plan to address fraud and waste within the Medicaid system. States receive more federal funds for Medicaid expansion enrollees than those who qualified pre-expansion, creating an incentive for mis-categorization.
According to the Washington Post, the recent government reorganization plan proposed by the Trump administration would move and consolidate several safety net programs, while also standardizing work requirements. The reorganization coincides with a budget proposal that would also cut funding for these programs.
The proposed government reorganization plan isn’t just about consolidating agencies; it also focuses on technology. NextGov reports the plan would require agencies to digitize all paper processes, improve customer service, modernize their websites, and improve digital portals.