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President signs Medicaid minibus reauthorizing coordinated care programs important to counties

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President Trump signed a Medicaid microbus with provisions to support “health homes” and protect against spousal impoverishment for recipients of community-based services Medicaid coordinated care programs included in the microbus legislation help communities develop infrastructure to support older adults & people with disabilities

On April 18, President Trump signed the Medicaid Services Investment and Accountability Act (P.L. 116-16), a legislative package containing provisions to improve care coordination in the Medicaid program. The “minibus” collection of bills reauthorizes the Money Follows the Person (MFP) Medicaid demonstration program through September 30, 2019, delivers a $20 million boost to the program and creates a state Medicaid option to provide coordinated care through health homes for children with complex medical conditions. The bill also contains smaller provisions protecting against spousal impoverishment and preventing the misclassification of drugs in the Medicaid program.

Both the MFP demonstration and the new Medicaid health home option help fulfill counties’ mission of providing a continuum of care to residents. The MFP program, first authorized in 2005, enhances federal support for state Medicaid programs transitioning nursing home residents back into community-based settings. Since it was first enacted, MFP has enabled 43 states and the District of Columbia to develop the infrastructure to help older adults and people with disabilities live in the settings of their choice, while achieving lower institutional admission rates and cost savings to the Medicaid program.

Meanwhile, the bill’s creation of the state Medicaid option for children’s health homes is expected to offer a central point for children’s health care delivery, including a full range of primary care, behavioral health and outpatient services. These facilities will also share medical data across health providers in different states, which could reduce duplication of services and emergency room visits for children with medical complexities.

The additional flexibility provided under these programs has been shown to enable counties to fill coverage gaps and provide wraparound services to residents. Although Medicaid operates as a federal-state program, counties play a central role in financing and administering Medicaid services to residents. NACo supports Medicaid coverage of community-based long-term care, as well as the creation of state Medicaid options to cover children’s health conditions.

President Trump’s approval of the Medicaid minibus follows the short-term reauthorization of the MFP demonstration in January 2019, as well as efforts to pass a similar legislative package toward the end of the 115th Congress. In November 2018, NACo sent letters urging House and Senate legislators to extend funding for the MFP demonstration. NACo will continue to engage with Congress on Medicaid proposals, especially as lawmakers prepare to consider legislation related to federal health safety-net programs later in the 116th Congress.

For more information on the relationship between the Medicaid program and counties, please see NACo’s recent report, Medicaid and Counties: Understanding the Program and Why It Matters to Counties, which outlines the role Medicaid plays in our nation’s health system, how counties contribute to the federal-state-local partnership and key messages for advocacy.

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