Medicaid makeover

The Medicaid Fiscal Accountability Regulation would change many aspects of the Medicaid program.

Reporting changes

Under the proposed changes to the upper payment limit, states that want to add or renew supplemental payments would have to report considerably more information and go through an intensive review process. States would need to have their payments reapproved by the CMS every three years.

States would have to quantify their yearly audits of disproportionate-share hospital payments.

Reimbursement changes

Supplemental payments to doctors under the upper payment limit would be capped at 50% of base payments or 75% in rural areas and other regions with a shortage of clinicians. The CMS estimated the change would cut Medicaid payments by $222 million nationwide.

Medicaid financing changes

The proposed rule would also rein in the ability of states to raise their portion of Medicaid money by clamping down on their ability to impose healthcare taxes such as provider taxes. It would also limit states’ power to raise funds from intergovernmental transfers, certified public expenditures and provider donations. These changes would likely cut Medicaid spending overall by lowering state-generated Medicaid funds and the corresponding matching federal dollars.

States also wouldn’t be able to adjust fee-for-service payments for Medicaid services according to eligibility or for enrollment based on a waiver.