ASH has urged the Centers for Medicare & Medicaid Services to proceed with caution when attempting to update regulations governing Medicaid managed care.

In a letter to CMS in response to the proposed regulation, the Alliance of Safety-Net Hospitals expresses support for “…the admirable intent behind much of this proposed regulation” but notes that a number of changes the agency proposes would take certain prerogatives away from state governments and give them to the federal government instead – a shift ASH opposes.  In particular, ASH calls for CMS not to needlessly limit the ability of states to use so-called state directed payments (SDPs) made to selected providers by the state through Medicaid managed care plans.  Those SDPs, ASH wrote, “…have become a vital tool for states to improve the adequacy of their Medicaid payments” and

This is vital for health care providers – and especially for community safety-net hospitals, which care for disproportionately large numbers of low-income, uninsured, and Medicaid-covered patients.  In some states, SDPs have made a considerable difference in the adequacy of Medicaid payments, enabling providers to do more for their Medicaid patients and to enhance equitable access to care in the communities they serve.

In addition to addressing this and other aspects of SDPs, ASH’s letter expresses concern about CMS’s proposal to regulate Medicaid managed care plans’ provider networks, conveying its support for efforts to encourage those plans to have adequate networks of providers to serve their members but suggesting that the proposed remedies are unlikely to address the problem effectively.

Learn more about ASH’s response to proposed changes in federal Medicaid managed care regulations in this letter to CMS on the proposed Medicaid managed care regulation.