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NAMD Statement on Medicaid Reforms and the Future of the ACA

December 14, 2016

NAMD Statement on Medicaid Reforms and the Future of the ACA

Washington, DC – The Medicaid program is the nation’s health care safety net and the largest health insurer in the country. Administered by the states within a broad federal framework, Medicaid serves more than 73 million Americans and spends more than $500 billion per year serving the oldest, sickest, frailest and most medically complex patients in the nation. Medicaid covers almost half of all the births in the country, about 1/3 of all children up to age 18 and many low income working families. However, the bulk of Medicaid’s costs come from its dominant role in delivering mental health benefits, a variety of services for individuals of all ages with physical, developmental and intellectual disabilities, and an outsized yet underappreciated role in providing long-term care and other services for millions of Medicare beneficiaries.

Medicaid is one of the most complex programs in all public policy, and the state Medicaid Directors who administer it are uniquely positioned to be able to provide critical insight into its inner workings and its reform. Due to their combination of operational, policy and strategic perspective, any substantive changes to how the US health care system works must involve state Medicaid Directors directly at the table. This will be true on both discussions around the repeal and replacement the Affordable Care Act (ACA), as well as consideration of structural and financing changes to the Medicaid program itself.

As Congress and President-elect Trump’s incoming administration prepare for 2017 and the consideration of these changes, it will be necessary to acknowledge policies from the ACA that have become woven into the fabric of the current health care system. In addition, Medicaid’s role in the health care system must be understood and appreciated to prevent serious unintended consequences for the oldest, frailest and most medically complex Americans. Therefore, any substantive changes to Medicaid’s financing structure must be done in close consideration of the complex and interconnected web of statutory and regulatory requirements. Failure to do so could expose states to the greatest inter-governmental transfer of financial risk in the country’s history.

NAMD has developed two key documents to assist federal policymakers and other key stakeholders as they engage in these important discussions.  One is a list of considerations for the debate around the repeal of the Affordable Care Act and the other is a list of considerations for the debate around restructuring the underlying Medicaid program itself.

State Medicaid Directors use every tool available to drive the program to be as effective and efficient as possible, to provide high quality services to those most in need, while being responsible stewards of the taxpayer dollar. The statutory levers that are necessary to influence this must come from the following areas: eligibility, payment, benefits, cost sharing, and administration.  Outside of these key areas, change must come from fundamental reform of the underlying health care system, especially with respect to how care is delivered and how financial incentives are aligned. State Medicaid Directors are actively and aggressively working on these priorities, and continue to welcome all federal support in their efforts to improve the cost and quality of the health care we deliver.

The National Association of Medicaid Directors (NAMD) is a bipartisan, nonprofit, professional organization representing the leaders of Medicaid agencies in all 56 states and territories across the country. NAMD exists to serve state Medicaid Directors and to ensure that they play a vital role in conversations about the program’s future.

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