Medicaid plays a significant role in providing care to many low-income, vulnerable individuals, including children, the elderly, and individuals with disabilities. Medicaid also plays a role in financing long-term services and supports not covered by Medicare or private insurance. While Medicaid will continue to play an important role in providing coverage for at risk populations, under the new Trump administration we can expect fundamental changes to the financing structure of Medicaid.
Republicans have long wanted to move towards Medicaid block grants where states receive a fixed lump sum every year instead of the current federal matching program under the Affordable Care Act (ACA). These grants would increase with population growth and the overall cost of living, but not with economic conditions. From the federal perspective, block grants may limit liability, make funding more predictable, and generate savings. From the state perspective, however, this change could mean shifting the cost and risk to states, providers, and beneficiaries.
Comprehensive Care Coordination
In order to make Medicaid programs efficient under the block grant model, states will need to focus on reducing costs through data-driven care coordination and delivery system reform. Care Coordination involves doctors, hospitals, and other community health providers forming networks to address all aspects of patient health. Addressing the social determinants of health and providing whole person care reduces high cost care, such as emergency department visits and hospital readmissions. It also helps Medicaid ACOs achieve shared savings targets.
Care coordination can be a struggle for providers who lack the data, infrastructure, and community collaboration to support patients across the care continuum. A comprehensive care coordination technology platform connects provider organizations and shares patient data in order to create better outcomes and reduce costs. It also helps providers determine where costs can be cut and redirects precious resources towards new programs, departments, facilities, equipment, or staff.
Change is almost certain for Medicaid providers in the near future. States, localities, and beneficiaries will need to make adjustments in order to do more with less. Now is the time to focus on improving efficiencies and reducing costs through data-driven care coordination to ensure critical services are continued for the most vulnerable populations – the disabled, our children, and our parents.