Medicaid is the Best: Part 1

Medicaid is my personal favorite federal (more accurately federal-state partnership, but you get what I mean) program.  If you read this blog regularly I will attempt to convince you of that fact and you too will love Medicaid.  Soon, we all will be on Team Medicaid and I will finally have a purpose for these hundreds of t-shirts I ordered.*

Today: Medicaid as an innovator.

I’m 100% positive that my former coworkers at CMS would want me to write about this new Medicaid Innovation Accelerator program that they just announced today. I’ll save that for later. Right now, I’ll direct your attention to another report issued today: Medicaid Moving Forward report. Read it! It’s fun and has pictures and maps!

Did you catch the fact on page 9?  This one?

Section 1115 Demonstrations — In 2013, CMS approved 98 section 1115 demonstration actions implementing delivery system reforms, expanding benefits and services, and transitioning newly eligible populations into 2014 coverage.


If you don’t know what Section 1115 demonstrations are- they are basically plans that states submit to the federal government to waive federal law around the Medicaid program.  Section 1115 refers to Section 1115 of the Social Security Act.  These waivers allow states with the necessary flexibility to amend the Medicaid program to best meet the needs of the state.  They are demonstrations- meaning they are generally time limited which forces the state and federal government to continue to examine the impact of those changes.

States truly are the laboratories for reform and 1115s are the tools that fill the lab.  1115s range in size and scope and could be anything from minor adjustments to the Medicaid program focusing on a small specific population to vast changes in the program such as the Massachusetts health reform efforts under Gov. Romney. There are limitations to the waivers- budget neutrality, beneficiary protections, etc., but states have historically made extensive changes through this flexibility. I’ll get more into these waivers and the processes behind them more at a later point.

Critics of CMS sometimes argue that CMS does not allow state innovation and rejects attempts by states to reform and improve Medicaid.  If allowing nearly 100 different improvements in state Medicaid programs through this one of many avenues within a year is not flexible, I struggle to understand what is.


* I did not actually order Medicaid t-shirts, but am more than happy to if Team Medicaid is actually formed.


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