State of play
Budget reconciliation process is back in full swing, while some wonder (and may worry?) about 1115 waivers.
It’s Day 66 of the Trump administration, and the Senate and House are crunching to get a joint budget resolution done to guide reconciliation before the April recess. There’s a lot we don’t know, but many constituencies — people, providers and others — are pushing back against potential federal Medicaid cuts that would threaten coverage and benefits from millions. Some conservative lawmakers have even weighed in: Sen. Josh Hawley (R-Mo.) this week said he won’t support Medicaid cuts. In other news, states are eyeing the possible rescission of 1115 waivers, many of which support health-related social needs. Tell us what you’re watching in the comments.
Waiver Worries? States Should Stay the Course on Medicaid 1115 Demonstration Implementation
Much of the focus in these past weeks among Medicaid policymakers has been on Congress and the unfolding budget reconciliation process, and rightly so. The next step in the process — an agreement between the Senate and House on a budget resolution that offers committee instructions that will guide reconciliation efforts this spring (and perhaps summer) — is picking up steam. We understand that the goal is to have the two-chamber resolution on the floor during the next three weeks. As we’ve discussed extensively in recent issues of The 80 Million, there is much at stake for Medicaid. Proposals being considered would, if passed, make unprecedented changes to the structure and level of Medicaid program funding, undercutting coverage, benefits and access for the people who rely on the program for health care.
But today, we reflect on other potential changes that may be brewing for Medicaid, specifically for Section 1115 Medicaid demonstration waivers.
Keep reading at The 80 Million.
ICYMI: One (Real) Solution To Mitigate Medicaid Fraud and Waste: Artificial Intelligence
A new, primary talking point among Republicans seeking to rationalize proposed deep cuts to federal Medicaid funding is that the nation needs “to address fraud and waste in Medicaid.” We don’t know of a single state Medicaid director who would disagree with that statement. State Medicaid agencies serve dual roles of regulator and payor — chief among those roles is stewardship of federal and state Medicaid funding to ensure that the lion’s share of resources goes to health care coverage and access for Medicaid enrollees. Slashing federal Medicaid funding isn’t a solution to fraud and waste in Medicaid, but AI is.
Three priority areas in which Medicaid programs and the Trump Administration should consider investing in and deploying AI technology include:
Eligibility and enrollment
Program oversight and integrity
Network adequacy and access monitoring
Keep reading at The 80 Million.
The Peterson Health Technology Institute released a report on ambient scribes, or an AI tool that clinicians use to automatically draft clinical notes from verbal conversations. The report details how AI tools are beginning to change care delivery and early lessons from ambient scribes.
Analysts speculate about how Medicaid cuts might be made – State House News Service
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