Medicaid: The backbone of U.S. health care

Medicaid spending accounts for about three percent of annual U.S. GDP and more than 20 percent of most state budgets. With a ten-year run of a strong economy, we may be due for a downturn, which creates a perfect storm for Medicaid directors. 

In an economic downturn more people become eligible for Medicaid programs while state revenues are in decline. Common strategies to deal with this have been to raise the bar for enrollment, cut benefits and or cut payment rates.  In the past ten years, the National Association of Medicaid Directors (NAMD) has been a venue for its members to share many ideas, an important one being a fourth strategy that might mitigate the impact of an economic downturn: transforming healthcare delivery.

Matt Salo, the Executive Director of NAMD describes ways the 56 U.S. states and territories (can you name them all?) have been working on healthcare transformation. A Medicaid agency of the past may have described the speed at which they pay claims as a measure of success, but now the focus is on improving cost trends, quality and the experience of care.

The 2-3 year future of Medicaid includes pressures from the current administration’s interest in price transparency, accountability and costs. NAMD’s members will continue to focus on payment reform in ways that recognize local issues, and Matt sees growing interest in how Medicaid addresses behavioral health, social determinants of health and adverse childhood events.

Come listen to the Inside Angle podcast as Matt describes how Wyoming and Connecticut are testing similar strategies, what NAMD members are thinking about MCOs and ACOs, and how these complex agencies work across long term services and support HIV & AIDS care, mothers & babies, SNAP and more.

L. Gordon Moore, MD, is Senior Medical Director, Clinical Strategy and Value-based Care for 3M Health Information Systems.