CMS to guide states testing new Medicaid financing approaches

CMS will issue guidance for states to test alternative Medicaid financing approaches such as block grant and per capita cap proposals, CMS Administrator Seema Verma said.

Some states have shown interest in exploring such principles through section 1115 demonstrations, and the new guidance will outline initial opportunities for states to test new Medicaid financing approaches for certain optional adult populations, she told attendees Nov. 12 at the National Association of Medicaid Directors conference in Washington, D.C.

"The Medicaid value and accountability demonstration won't compromise important beneficiary protections, but it will inject rigorous accountability for outcomes, provide significant and unprecedented flexibilities for program operation and offer opportunities for shared savings that can be reinvested back into Medicaid," said Ms. Verma.

She did not give a precise timeline but indicated that CMS will issue the guidance soon. 

Ms. Verma said the guidance is part of overall CMS efforts to allow states more flexibility and budget certainty with their Medicaid programs, while being held accountable for improving outcomes.

She said CMS will also issue guidance later this year to "help states maximize opportunities to support value-based payment in Medicaid through our existing authorities." 

The agency also will provide more guidance to states on how they can address the social determinants of health amid the continued industry shift toward value-based care, she said. 



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