On April 18, NACo submitted responses to the Centers for Medicare and Medicaid Services (CMS) in response to their Request for Information (RFI) calling for stakeholder feedback and recommendations on increasing access to health coverage and care under Medicaid and the Children’s Health Insurance Program (CHIP). The RFI solicited responses on topics including program enrollment and coverage, service to vulnerable and diverse populations and the impact of provider payment rates on provider availability and quality.

In response to the RFI, NACo underscored the vital role counties have as investors, implementers and innovators of Medicaid services. As a federal, state and locally funded program, counties in over half of all states contribute to the non-federal share of Medicaid. In addition to fiscal investments, counties administer services through local hospitals, long-term care facilities, local health departments and behavioral health facilities and work innovatively to serve the needs of our most vulnerable residents.

To support counties in improving health care access and coverage, NACo provided the following recommendations to CMS in response to the RFI:

• Assess unique access and retention barriers for priority populations through engagement with county stakeholders
• Expand the Marketplace Navigator Grant Program for improved outreach efforts, and emphasize navigator diversity
• Amend exclusionary policies, such as the Institutes for Mental Disease (IMD) Exclusion and Medicaid Inmate Exclusion Policy (MIEP), that limit access to Medicaid services and deepen disparities in health outcomes in certain populations
• Create a sustainable mechanism to address disparities in maternal and infant health outcomes by removing the sunset on the Medicaid postpartum extension option
• Consider monitoring county economic trends to assess the need for greater flexibility in Medicaid eligibility determinations
• Seek input from counties in conjunction with our state partners to identify possible improvements in eligibility redeterminations

Counties support the implementation of CMS’s strategic vision for Medicaid and CHIP, and are committed to working collaboratively with state and federal partners to reduce barriers to healthcare access and ensure adequate availability of high-quality health care for all residents.

Additional Resources 

• NACo Report: Medicaid and Counties
• NACo Policy Brief: Protect the Federal-State-Local Partnership for Medicaid
• NACo Blog: CMS seeks feedback on access to health care services and coverage through Medicaid and CHIP