Medicaid reform – A Tale of Two States

Medicaid provides health and financial security for millions of low-income, working Americans. Despite the fact that Medicaid is as efficient as (or even more efficient than) private insurance, it is often a target of state budget cuts. As we look to the future of Medicaid, advocates will need to play a vocal role in Medicaid budget discussions, both to defend Medicaid from harmful cuts, and to direct the discussion toward meaningful reform. Rhode Island and Ohio are two tales that illustrate how persistent advocate engagement in Medicaid reform is beneficial and critically important for consumers and state budgets.

Rhode Island: A Tale of Reform

Concerns about costs resulted in calls to dramatically reduce Rhode Island’s Medicaid budget. Luckily, consumer-friendly leaders like Governor Gina Raimondo (D) and other key officials set a positive tone for the state’s Medicaid reform efforts. Earlier this year, Governor Raimondo created the ‘Working Group to Reinvent Medicaid,’ with a goal to reform the Medicaid system over the long term while cutting $90 million from the Medicaid budget in 2015. 

With policymakers, advocates and industry representatives invited to the table, the Working Group proposed initial recommendations for FY15-16 budget savings that are a win-win for the state and consumers. These recommendations implement programs advocates have long been calling for. Below are a few highlights from the Working Group’s report, in which Rhode Island’s Medicaid program will:

• Aim to reduce unnecessary hospital utilization
• Improve quality and develop new payment arrangements that award value over volume
• Temporarily decrease hospital payment rates and increase provider assessments
• Pilot a hospital-based Accountable Care Organization (ACO) model that focuses on patients with long-term and complex needs

A final report with recommendations for long term reforms was published  and presented to Governor Raimondo earlier this month.

Ohio: A Tale of Advocate Intervention

In Ohio, Governor John Kasich (R) proposed dramatic rollbacks in coverage for certain Medicaid benefits. Unlike in Rhode Island, consumer health advocates were not invited to the table to help design savings initiatives. As a result, the state advanced harmful proposals that would make coverage harder to access.

Although they were not part of the initial policy discussion, advocates immediately jumped into action.

• They challenged the harmful assumptions that the cuts would save money and that beneficiaries could get care through other means by using data and policy analysis.
• Advocates organized call-in days, sign-on letters, and sent action alerts to their lists.
• Advocates also found a legislative champion in the Republican Party (Republicans the state Senate and House) to introduce an amendment to these proposals.
• They then called on strategic stakeholders and partners to carry the message. For instance, advocates worked with the Ohio chapter of the American Cancer Society to lobby against cuts to breast and cervical cancer screening coverage.

Advocates’ efforts paid off. They prevented rollbacks in eligibility for pregnant people and coverage for cervical and breast cancer screening. Unfortunately, the state still cut coverage for family planning services and health savings accounts, increased cost-sharing for some, and blocked the expansion of an innovative coordinated care model.

The Moral of the Stories

What lessons do the tales of these states teach us?

1. Start early. It’s never too early to meet with your coalition and start planning to defend and/or reform Medicaid. Medicaid is chronically on the chopping block during state budget deliberations, so working with your coalition partners to proactively develop a Medicaid reform agenda will prepare you for this eventuality. It can also serve as a guide and reference for educating the public and lawmakers about the importance of this program. In addition to Rhode Island’s Reinventing Medicaid reports, check out Arkansas Advocates for Children and Families’ Top Ten Principles for Health Reform.
2. Educate policymakers about the importance and benefits of Medicaid. Work with legislators to develop smart, consumer-friendly reforms to the Medicaid system, and cultivate them into champions for these reforms. Leverage your coalition partners and grassroots organizers to amplify the message through legislative meetings, lobby days, in-district events, and the media.
3. Be creative. While planning your Medicaid defense/reform agenda, consider how Medicaid funds social services outside of the traditional health care system, such as supportive housing and housing infrastructure, early childhood development, and mental health and substance use disorder services. Explore how you can integrate the message of Medicaid system reform into these spaces, as well as pull unlikely partners into your Medicaid campaign.
4. Collect data and stories. Press your state Marketplace and Medicaid office for data on who is falling through the gaps and who is churning off of Medicaid due to cuts. Boost this data with stories of real consumers who are falling through new coverage gaps. Refer to the Families USA story-banking toolkit for more resources to help you collect stories.
5. Grow your lists and mobilize your grassroots. Lift up the voices of consumers who are falling through the gaps by helping consumers understand how to connect with their legislators. Advocates can also organize activities for consumers to engage in throughout the year so that legislators understand what their constituencies want before they need to start budget negotiations.

We know that this is not an easy battle, nor a new one. But we encourage you to get creative, strengthen old partnerships and engage new ones. Let’s work together to shift the conversation away from harmful cuts, and toward “Reinventing Medicaid.”