By Ed Smith

The Affordable Care Act has been affirmed by the U.S. Supreme Court and states have the option to expand Medicaid.

So are states now ready to stop worrying about innovation in Medicaid?

Not by a long shot, according to a panel of experts from Washington and Utah who talked about their Medicaid innovation efforts at a panel Wednesday at NCSL’s Legislative Summit in Seattle.

“Medicaid reform is not new to most states,” said Joan Henneberry from the Department of Health Care Policy and Financing in Colorado, who moderated the session, Beyond the Status Quo: Tackling Medicaid Systems Reform.

The change, she said, is that in the past many of the reforms involved expanding coverage while now the focus has shifted to providing better care, reducing overall costs and improving the experience of patients.

Nathan Johnson, chief policy officer of the Washington State Health Care Authority, pointed out that his state did expand Medicaid and ended up with twice as many new adult enrollees as expected. That presents new challenges in a system that in the past had much smaller adult enrollment.

Washington Senator Randi Becker (R) noted the state has a long history of Medicaid reform. “I don’t think Washington will ever stop reforming.”

Those reforms, however, can be daunting when dealing with the federal Centers for Medicare and Medicaid Services (CMS), said Utah Representative James Dunnigan (R). In general, he said, CMS is quite opaque when it comes to providing guidance on what waivers from Medicaid rules will be allowed.

“It’s like a treasure hunt,” Dunnigan said. “We asked [CMS officials] for yes or no answers and they said, ‘We’d have concern about that.’ After an hour we got two nos. At least we got an answer.”

All the panelists agreed Medicaid innovation has to continue to drive their health care systems toward better integration of care where primary care physicians monitor a patient’s primary, specialist, behavioral, oral and other health care needs.

They also saw real promise in efforts to give Medicaid patients more say in health care decisions. In Washington, Johnson said there was evidence that discussions between providers and patients often saw patients choosing the less invasive, and often less expensive treatment.

The panelists also seemed to agree that similar discussions between the states and Medicaid would be needed if those relationships are to remain healthy.

Ed Smith is NCSL’s director of Digital Communications.

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