Proposed Rule Will Reduce Access to Medicaid Services

Posted on Friday, May 4, 2018 3:39 PM

CMS is currently receiving comments on a proposed rule that would allow states to make reductions in the Medicaid reimbursements, which could result is less access to care for Medicaid beneficiaries.

“Under current law, states are required to set Medicaid rates at a level that would ensure access to services for Medicaid beneficiaries at a comparable level to non-Medicaid insured individuals. This rule, known as the equal access provision, enabled patients and providers to hold the state Medicaid program accountable for keeping competitive rates, and as a deterrent against rate stagnation.

In their current rulemaking, CMS has proposed exempting states from the review process if the state has a Medicaid population where 85 percent of beneficiaries are covered by a managed care organization. This will apply to 17 states. In the proposed rule, CMS also defines a “nominal” rate reduction as one of up to four percent for one year, or six percent for two years. If a state were to adjust within these parameters, they would not have to report it. Extrapolated out, a state could make a downward adjustment of up to 12 percent over four years without any reporting necessary.”


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