Mass. seeks to move adults off Med­i­caid, limit drug cover­age

Modern Healthcare - - REGIONAL NEWS - —Vir­gil Dick­son

Fac­ing steadily ris­ing costs, Mas­sachusetts has sought fed­eral per­mis­sion to cull its Med­i­caid rolls, curb ac­cess to in-home and long-term care and sup­port ser­vices and limit the num­ber of drugs it must cover.

Mas­sachusetts has seen its Med­i­caid and Chil­dren’s Health In­sur­ance Pro­gram pop­u­la­tions jump more than 30% since it ex­panded Med­i­caid un­der the Af­ford­able Care Act. Med­i­caid cov­ers 1.9 mil­lion Mas­sachusetts res­i­dents, or onethird of the state’s pop­u­la­tion.

But as the fed­eral gov­ern­ment no longer cov­ers the to­tal cost of ex­pan­sion, Mas­sachusetts said it needed to slim down the pro­gram be­cause the costs are un­sus­tain­able.

“At 40% of the com­mon­wealth’s bud­get, MassHealth’s con­tin­ued growth will con­strain the state bud­get un­less sig­nif­i­cant re­forms are im­ple­mented and key as­pects of the pro­gram are re­struc­tured,” Marylou Sud­ders, state health and hu­man ser­vices sec­re­tary, said in a Sept. 20 let­ter to CMS Ad­min­is­tra­tor Seema Verma.

The CMS will ac­cept com­ments on the state’s waiver re­quest through Oct. 20.

Mas­sachusetts’ share of Med­i­caid spend­ing jumped 20% from $6.4 bil­lion in fis­cal 2013 to $7.7 bil­lion in fis­cal 2016, ac­cord­ing to fed­eral data.

The state has asked for per­mis­sion to move child­less, non-dis­abled adults with in­comes above the fed­eral poverty level into sub­si­dized com­mer­cial plans through the state’s exchange. Arkansas uses a sim­i­lar model to cover this pop­u­la­tion.

Un­der the pro­posal, non-dis­abled ben­e­fi­cia­ries at or be­low the poverty level would be moved to a ver­sion of Mas­sachusetts’s Med­i­caid pro­gram that does not cover longterm sup­port and ser­vices, such as per­sonal care at­ten­dants.

The state also seeks to cre­ate a for­mu­lary that would limit which drugs the state would have to cover for Med­i­caid ben­e­fi­cia­ries, mak­ing the state’s pro­gram more sim­i­lar to a com­mer­cial in­sur­ance plan.


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