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A Framework for Medicaid Reform

AHCA Urges Comprehensive Reform


Medicaid Reform

The majority of Americans who require long term services and supports (LTSS) rely on Medicaid to pay for their care each day. And this number is only expected it increase over the next few decades.The challenge to policymakers is to respond to the growing need for LTSS and assure adequate safeguards are in place to protect the most frail beneficiaries across the various care settings.

To help be a part of the solution, AHCA has developed a framework for Medicaid finance reform comprised of the policy principles listed below. We welcome the opportunity to work with Congress and the Administration on innovative ideas that can address the real challenges ahead in terms of providing quality LTSS, while preserving the Medicaid safety net.


 Reform Principles

  • Any revisions to the state-federal Medicaid partnership must recognize the changing demography of our nation (e.g., rising numbers of older adults, disability prevalence) and ensure adequate funding for long term services and supports.
  • Proposals must include minimum federal standards to ensure adequate access to needed services.
  • Because Medicaid is the key source of long term services and supports financing, no changes to Medicaid-financed services for long term care populations should be made until viable private options have been identified.
  • Proposals should promote individual planning for long term services and supports.
  • Proposals must emphasize efficiency by focusing on funding only services that are medically necessary. Financing for these medically necessary services must be sufficient to support high quality of care.
  • Policymakers must ensure that any transition to a new Medicaid payment and delivery system is gradual and allows for adequate consumer and provider input on the implementation process.
  • Any Medicaid reimbursement program based on quality of care or efficiency should be developed collaboratively, involving all stakeholders. It should recognize differences among provider types and the people they serve.
  • Any reform effort must address Medicaid financing challenges, including the counter-cyclical nature of the Medicaid program and heavy reliance upon upper payment limit-related financing mechanisms.
  • Proposals should not shift costs from the federal government onto states, local governments, or providers.