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Capitol Correspondence - 11.15.21

Medicaid Expansion Leads to Shift in CMS’ Focus on Alternative Payment Methods

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The Center for Medicare & Medicaid Innovation (CMMI), as part of the Centers for Medicare & Medicaid Services (CMS), has announced it will shift its focus on alternative payment models (APM) from Medicare to Medicaid. This shift is largely driven by the dramatic increase in Medicaid enrollment resulting from the COVID-19 pandemic and a commitment to improving the Medicaid program through APMs.

CMMI’s focus for alternative payment and delivery system models has been threefold: reducing federal expenditures, lowering out-of-pocket costs for Medicare and Medicaid beneficiaries, and maintaining access to quality care. However, it is now seeking to address barriers to participation in CMMI models by health care providers that serve a high proportion of underserved people.

Speaking on behalf of CMMI, policy and programs group director Ellen Lukens noted that previously, “[m]odels have been predominantly Medicare-oriented, and have disproportionately served white beneficiaries.” Part of CMMI’s shift to Medicaid is a focus on both health equity and a reduction in the number of models to alleviate complexity and confusion. It also seeks to set better financial benchmarks.

For more analysis of CMMI’s shift to Medicaid, see CMS’s Innovation Center To Increasingly Focus On Medicaid As Expansion Of The Program Accelerates.