EDITOR’S NOTE: Projected to cover a record 65 million Americans in 2014—and as many as 1 in 4 by 2020—Medicaid will play a significant role in shaping the strategies and plans of all healthcare stakeholders in the years ahead, from states to providers to payers to life sciences companies to, of course, consumers.
To ensure your organization can anticipate and prepare for the transformative changes ahead, the Medicaid team at Manatt Health will be producing an ongoing series of briefs—Manatt on Medicaid—throughout the year. The first edition follows the top-ten trends that will be the central drivers of Medicaid transformation in 2014, summarized below. To download the full brief click here.
Trend 1: New Wave of Medicaid Expansions: Looking to the Private Market. With an eye on the economics, states that have resisted Medicaid expansion will take another look, triggering a melding of public and private coverage models.
Trend 2: Calls for Personal Responsibility: Expecting “Skin in the Game.” A growing number of states will pursue waivers for more cost-sharing, premiums and healthy behavior initiatives for Medicaid consumers.
Trend 3: Alignment and Integration with the Private Market. Commercial insurers will enter the Medicaid space. Medicaid managed care plans will experiment with Marketplace products. In addition, states will advance integration by regulating more consistently across markets.
Trend 4: A Focus on Promoting Stability of Coverage. States will move beyond outreach and initial enrollment. They will begin to focus on renewing and maintaining coverage of those already enrolled.
Trend 5: Medicaid Managed Care and Beyond: Payment Reform in an Expanding Market. States will move more people, including those with complex conditions, into managed care and become increasingly sophisticated about using provider-driven payment strategies to achieve accountable care.
Trend 6: Behavioral Health Taking Center Stage. States, insurers and providers will continue to integrate behavioral and physical healthcare even as they face the challenge of new mental health parity requirements and, in expansion states, the significant behavioral health needs of newly insured populations.
Trend 7: Coordinated Care for Dually Eligible Patients. States preoccupied by Affordable Care Act (ACA) implementation in 2013 will turn their attention to managing costs and improving quality of care for the high-cost, high-need dual eligibles. Significant numbers of beneficiaries will begin to enroll in dual demonstrations for the first time.
Trend 8: Continuing Spotlight on Pharmaceutical Coverage and Costs. States will take a hard look at their pharmacy policies in light of new medications coming on the market, the mental health parity requirements and, in expansion states, the need to meet the prescription drug needs of newly eligible adults.
Trend 9: Waivers and More Waivers: New Investment in Delivery System Transformation. A growing number of states will pursue delivery system reform using federal waivers. Keep an eye on 1115 waivers with “Delivery System Reform Incentive Payments” (DSRIP waivers) to increase federal funding for state transformation efforts generally, and hospitals specifically.
Trend 10: IT Investment: From Mitigation to Innovation. Taking advantage of the robust federal support that remains available for information technology (IT), states and their vendors will continue to tackle the challenges of ACA eligibility and enrollment requirements. Providers and plans will invest in system analytics to support population management.