Session 6 -CMS & Mass Marriage Counseling

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Today marks the 6th extension granted to the Commonwealth for the Medicaid waiver that serves as the foundation for our 2006 reform. I have written about this before here and here.

As a review, the Massachusetts MassHealth 1115 waiver from the federal government allowed the 2006 health reform to become a reality financially. The waiver was last negotiated by the Patrick Administration in 2008, and was extended until June 30, 2011.

From SHNS this morning ($):

HIGH-STAKES MEDICAID TALKS DRAG ON: Secretive negotiations between the Patrick administration and the Obama administration over the distribution of billions of dollars in Medicaid funding have failed to produce an agreement and will continue into December.  The outcome of the talks, which are occurring as Washington looks to ratchet back spending and address bulging deficits, will have major ramifications for the state’s health care reform efforts….The Patrick administration is believed to be seeking a three-year agreement with the federal Centers for Medicare and Medicaid Services that includes billions of dollars in funding for hospitals that care for low-income and uninsured residents. U.S. Sens. John Kerry and Scott Brown, along with the entire Massachusetts Congressional delegation, pleaded with CMS chief Donald Berwick last month to preserve $4.6 billion to care for those uninsured or underinsured residents, as well as special payments to the hospitals that care for them….

Three layers to add to the discussion this month:

1. How will the resignation of Don Berwick impact this discussion?

From my understanding, he was very interested in this waiver issue. Which leads me to Q2…

2. When does this become a political issue in the Presidential race?

CMS sees this as an opportunity to save some money, and knows that  the Federal law is funded, in part, by similar cuts in Medicare Disproportionate Share Hospital (DSH) payments in the future. The National Association of Urban Hospitals estimates that private, non-profit urban safety-net hospitals will bear 45% of the cuts in 2014, but only account for 7.5% of the hospitals in the country. (Paging all urban members of Congress.)

If the Federal government can’t figure it out with one state run by a personal friend of the President who is ideologically similar, how will they conduct the process with hundreds of billions on the line?

Governor Patrick is slated to campaign for President Obama’s reelection and the ACA health care plan, but if the waiver is still unresolved, will reporters start to ask about it?

3. When will local political leaders on Beacon Hill start to engage on this issue?

One of the most confusing aspects about this process has been how few people know  about or are asking about the waiver renewal. This is the foundation of the Massachusetts reform, and all Beacon Hill can talk about is layering price controls and regulations on top of our health care system without even checking the health of what is underneath. Perhaps a step back is needed.

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