If a deal to reduce the聽deficit results in lower federal payments to states for Medicaid and the Children鈥檚 Health Insurance Program, then the National Governors Association will say no thanks.
As part of the ongoing negotiations between the White House and Capitol Hill, one proposal聽would聽combine the federal government鈥檚 Medicaid and CHIP payments into a single聽blended rate for each state. A analysis聽says that change would mean less federal funding for already cash-strapped states, likely forcing聽state governments to reduce services and cut payments to health care providers.
鈥淚f the blended rate 鈥� is intended to do some good things for the states for us to administer at the ground level, we鈥檇 like to have that conversation,鈥澛犅燝regoire, a Democrat, said. 鈥淚f on the other hand it鈥檚 code for dramatic cuts, that鈥檚 a different subject. And, unfortunately, that鈥檚 what most of the governors believe that it is. 鈥� If blended rates is code for cutting benefits and cutting people, that is going to be a huge problem to the states, where we鈥檙e already struggling because of the recession with increased case loads.鈥�
Department of Health and Human Services Secretary Kathleen Sebelius counters that 鈥渢he blended rate聽in and of itself doesn鈥檛 necessarily lower contributions to states. It really depends on what the underlying premise is.鈥�
鈥淚s it easier for states to have one rate and know what their match is? Probably. Is that something that then is going to be accompanied with a decrease in funding? That鈥檚 the point at which I think a lot of states are nervous,鈥� said Sebelius, herself a former governor. 鈥淚t鈥檚 really what happens with the underlying assumptions of what the federal contribution is.鈥�
A blended Medicaid-CHIP rate聽could also provide some administrative simplification to states, Sebelius noted.聽The CBPP analysis found聽that any administrative savings would be 鈥渟light.鈥�
Sebelius and Gregoire addressed the Medicaid blended rate issue during an HHS call with reporters 聽announcing the agency聽said would help states reduce the cost of care for 9 million Americans who are eligible for both Medicare and Medicaid, known as 鈥渄ual eligibles.鈥� 聽The proposal includes聽demonstration programs聽to test models to help states share the savings from coordinating care for duals and聽to help states improve the quality of care for people in nursing homes. HHS also announced a 鈥渢echnical resource center鈥� to help states improve care for dual eligibles.