Proposed Rule Would Ensure Access to Medical Care While Preserving States' Flexibility to Set Rates
For decades, the federal Medicaid law has provided that the states, in return for the billions of federal dollars they get for the program, must arrange the program in a way that ensures that Medicaid beneficiaries will be able to gain access to the medical care they need. This includes the issue of the rates that the program will pay to providers of healthcare services (doctors, hospitals, pharmacies, etc). States have great flexibility to set rates, but they must also pay attention to the impact that the rates have on access to care.
In the budget crisis prevailing in virtually every state, many states have begun to look to rate-cutting in their Medicaid programs. The federal Medicaid agency, noticing this trend, has issued proposed regulations reminding states that they continue to be responsible for assuring access to care, and that they must consider this obligation in their rate-setting decisions. As part of their overall assault on Medicaid, Republican governors and members of Congress plan to fight these proposed regulations, claiming (wrongly) that they represent a new federal assault on state "flexibility".
In fact, states have ample flexibility under Medicaid, including the flexibility to cut rates under some circumstances. But they also have a decades-long responsibility to assure access to care. There is nothing new in the proposed regulations--every state knew about this responsibility before it accepted billions of federal Medicaid dollars. What is new is the assertion that governors who accept billions in Medicaid dollars should the have "flexibility" to arrange the program so that people are denied healthcare and end up in more expensive emergency rooms.
The drive for Medicaid "flexibility" is in fact a drive to provide less health care to fewer people. You save money by providing less care--not rocket science, but not good policy either. It is also not much of a rallying cry, hence the paper-thin coat of "flexibility" paint that is being applied to it.
Experts from the National Senior Citizens' Law Center exposed the flimsiness of this argument in a blog for the American Constitution Society yesterday.
