Kaiser Family Foundation Issues Medicaid Budget Report

On October 19, the Kaiser Family Foundation released its report titled Medicaid Moving Ahead in Uncertain Times: Results from a 50-State Medicaid Budget Survey for Fiscal Years 2017 and 2018. The full report, as well as links to three affiliated and smaller reports, can be accessed here. Two highlights from the report are its focus on the increased carve-in of complex populations in managed care organizations (MCOs), and the increasing transition to community-based long-term supports and services (LTSS).

In its Executive Summary, the report states that “despite uncertainty about federal legislative changes, many states were continuing with efforts to expand managed care, move ahead with payment and delivery system reforms, increase provider rates, and expand benefits as well as community-based long-term services and supports. […] Key areas to watch include federal legislative efforts to restructure and limit federal Medicaid financing as well as Section 1115 waiver activity (state waiver proposals and CMS approvals). These issues will have implications for states, providers, and beneficiaries that could shape the future of the Medicaid program in FY 2018 and beyond.”

For your convenience, we have flagged sections of the report that could be of interest to IDD providers and the people and families they support:

• Eligibility Requirements:
  • Table 2 on pages 12-13 mentions that Colorado, Minnesota, Missouri, New Mexico, Ohio, Virginia and Wyoming changed eligibility requirements for “aged and disability” programs. For example, Missouri increased the limit for assets.
  • Additionally, Utah made changes to eligibility requirements for the “parent and caretakers” category.
• Managed Care Initiatives:
  • Figure 2 on page 15 showed states with comprehensive Medicaid managed care models.
  • The “Populations with Special Needs” section on page 17 includes tallies of states which include IDD populations in their managed care programs. A more detailed breakdown of this chart is available on pages 27-28.
  • The “Managed Care (Acute and LTSS) Quality, Contract, Requirements and Administration” section from pages 20-24 discusses topics of interest such as quality initiatives, including the use of social determinants of health.
• Emergency Delivery System and Payment Reforms:
  • Kaiser outlined key trends in this area on page 31, though IDD providers might be specifically interested in the report’s summary of telehealth initiatives on page 35.
• Long Term Services and Supports Reforms:
  • Providers will find this short section (pages 37-39) relevant as it discusses the general rising use of housing supports within LTSS as well as workforce initiatives that could help inform IDD-specific discussions and advocacy at the state level.
• Provider Rates and Taxes:
  • Tables 12-14 on pages 47-49 give a detailed breakdown of changes in provider rates and taxes, including the HCBS program and ICFs.
• Challenges and Priorities in FY 2018
  • This short section (pages 70-74) could be instructive for providers because it gives a sense of the big picture climate and priorities which Medicaid directors are operating in, and which concerns are driving their Fiscal Year 2018 planning.