- The National Association of Medicaid Directors (NAMD) argues that a hasty passage of the Medicaid reforms presented in the Graham-Cassidy bill will have significant consequences for public payer programs and the health outcomes of their beneficiaries.
“Our members are committed to ensuring that the programs we operate improve health outcomes while also being fiscally responsible to state and federal taxpayers,” NAMD said in a public statement.
“In order to succeed, however, these efforts must be undertaken in a thoughtful, deliberative, and responsible way,” the group continued. “We are concerned that this legislation would undermine these efforts in many states and fail to deliver on our collective goal of an improved health care system.”
The proposed bill’s restructuring of Medicaid financing into block grants would be to the detriment of state public payer programs, the group claimed. States are uncertain of how they would manage per-capita block grant funds and the bill’s potential implications for state-managed healthcare programs.
“Taken together, the per-capita caps and the envisioned block grant would constitute the largest intergovernmental transfer of financial risk from the federal government to the states in our country’s history,” NAMD said.
“While the block grant portion is intended to create maximum flexibility, the legislation does not provide clear and powerful statutory reforms within the underlying Medicaid program commensurate with proposed funding reductions of the per capita cap.”
Under the Graham-Cassidy bill, states would have two years and however many months to adjust to funding on a per-capita basis. Additionally, the bill would also require states to develop and invest in new oversight, strategies, infrastructure, and other developments.
“The vast majority of states will not be able to do so within the two-year timeframe envisioned here, especially considering the apparent lack of federal funding in the bill to support these critical activities,” NAMD added.
Proper analysis from stakeholders such as the Congressional Budget Office (CBO and healthcare experts are needed, and the currently proposed legislation lacks adequate analysis as a result of its rapid development.
Moving forward without a proper CBO score does not benefit states and beneficiaries, and swift passage could put a bill in place that has previously unknown consequences, the NAMD letter stated.
“With only a few legislative days left for the entire process to conclude, there clearly is not sufficient time for policymakers, Governors, Medicaid Directors, or other critical stakeholders to engage in the thoughtful deliberation necessary to ensure successful long-term reforms.”
Medicaid reform requires a more intensive, lengthier process than the proposals made with the proposed bill, and NAMD is encouraging collaboration with their organization towards proactive and thoughtful reform.
“For these reasons, we encourage Congress to revisit the topic of comprehensive Medicaid reform when it can be addressed with the careful consideration merited by such a complex undertaking — as we articulated in our June 26 statement on BCRA,” NAMD concluded.