Implementation has already begun. On its health reform website, the U.S. Department of Health and Human Services has started today to request comments on key issues, from rate regulation to the setting of medical loss ratios, so that premium dollars do to patient care, rather than administration and profit.
The Obama Administration also today released guidance, through a letter from the Centers for Medicare and Medicaid Services (CMS) to the states, on early expansion of Medicaid. Themore details on the state option to implement a Medicaid program for low-income populations (up to 133% FPL). States can elect to begin covering this population effective April 1, 2010, until 2014 when the requirement for all states will begin.
That’s the day when Medicaid expands: January 1, 2014. California should have a goal, that on day one, we get over a million of the newly-eligible onto coverage. With the federal government picking up the full cost for the first three years, there’s every reason to maximize those federal dollars to provide the most help for the most people.
We’ve thought a lot about how to achieve this goal, and wrote a paper on the subject of how to make our Medicaid waiver a bridge to health reform, with a variety of streamlining, early enrollment, and pre-enrollment strategies to get Californians covered on day one.
As I wrote in two posts on The New Republic’s The Treatment blog, Our philosophy is that Medicaid is a bargain, not a burden–the opportunity to get many Californians covered at little or no cost to our general fund. Medicaid can also be the centerpiece of a strategy for economic recovery, given the positive jobs impact for coverage.
How do we do it with the deficit in the state general fund? Maybe we don’t it this year, but we plan for when the economy comes around between now and 2014. Maybe we look at the county dollars that are now spent on providing care to those under the poverty level, and see if there’s a way to have those resources matched by these newly available federal funds.
So even given the severe budget crisis that California is under, we should look at the CMS letter, and see if there are creative ways to bring in dollars and begin to expand coverage, so we can be ready for January 1, 2014.