In a recent letter, America’s Essential Hospitals urged the Centers for Medicare & Medicaid Services (CMS) to grant states the flexibility to further their public policy goals while implementing Medicaid managed care. CMS currently prohibits states to directly pay providers in managed care models, with an exception for graduate medical education funds. However, states also have broader Medicaid program goals around population health, consumer protection, health equity, and systemwide access to quality care for all. The association supports modifying this direct pay prohibition to allow states to make payments for other public policy purposes identified in approved, actuarially sound state Medicaid plans.
Please contact Xiaoyi Huang, JD, director of policy, at firstname.lastname@example.org or 202.585.0127 with questions.