A final regulation giving states more flexibility in designing their own Medicaid programs - including adjusting benefit packages to more closely align with beneficiary needs - has been released by the Centers for Medicare & Medicaid Services.
"This new rule recognizes that states are in the best position to design plans that provide Medicaid beneficiaries better healthcare for the same or even lower cost," said CMS Acting Administrator Kerry Weems. "With this flexibility, beneficiaries will have more choices and greater control over their healthcare decisions."
The rule implements provisions of the Deficit Reduction Act of 2005. It is the latest in a series of regulations to meet the administration's goals of aligning Medicaid more closely with private market insurance and giving states more control over their Medicaid benefits packages.
Many of the regulations, however, are the subject of a Congressional moratorium, according to CMS.
Under the new rule, states can offer healthcare plans to beneficiaries that have the same value as plans offered to other populations in the state through alternative benefit packages called "benchmark plans."
Benchmark plans are used by states in designing new programs. They're similar to the flexibility provided to states under the State Children's Health Insurance Program (SCHIP).
Benchmark coverage includes:
- standard Blue Cross/Blue Shield preferred provider option service benefit plan under the Federal Employees Health Benefit Plan;
- state employee coverage;
- coverage offered by the largest commercial health maintenance organization in the state; or
- coverage approved by the Secretary of Health and Human Services.
Approved coverage may offer the opportunity for disabled individuals to obtain integrated coverage for acute care and community-based long-term care.
For those who can't afford the premiums associated with health insurance offered through their employer, states have the option of paying part of the employee premium, so the employee can maintain private coverage. These proposed rules also give states the flexibility to provide wrap-around and additional benefits, such as dental coverage.
"Until passage of the Deficit Reduction Act of 2005, states had few options, other than through waivers, to update the health benefit packages offered through their Medicaid programs to meet the needs of the people they serve," said Weems. "These changes allow states to use modern methods of providing health insurance coverage and encourage families to participate in their own healthcare decisions."