Medicaid Primary Care Solutions are Brewing at CMS

Something’s percolating at CMS – the agency that operates Medicaid and CHIP – with potential to connect more people to primary care and advance health equity.

In our complex health system, primary care knits together fragmented and uncoordinated parts of health care.  That’s important for all of us, but absolutely vital for the children, people with disabilities, rural residents, historically underrepresented communities and low-income adults who depend on Medicaid and CHIP.

At PCC, we are encouraged that CMS is attempting to tackle the challenge of strengthening Medicaid primary care with the draft Medicaid regulations, open for public comment until next Monday July 3rd. In April of last year, responsive to a Request for Information from CMS, PCC called on CMS to incorporate primary care as part of any access standards in Medicaid. 

In this year’s new proposals, CMS acknowledges the link between primary care access and chronic underinvestment in primary care. Here’s an early look at some of the provisions we expect to comment on.

  • Transparency: requiring states to compare their investments in primary care, behavioral health and OB-GYN services to benchmarks based on Medicare
  • Beneficiary Voice: Amplifying the voices of enrollees in decisions that impact their coverage and care, establishing in every state a new multistakeholder Medicaid Advisory Committee (MAC) along with Beneficiary Advisory Group (BAG) made up of previous Medicaid beneficiaries as well as Medicaid experts
  • Quality Care: helping beneficiaries and their caregivers decide which plan is best for them via a new transparent Medicaid and CHIP Quality Rating System

But as any practicing clinician could tell you, state- and plan-level requirements alone won’t be enough. CMS must press forward, leveraging updated guidance, scorecards, waivers and any other tool available, to strengthen primary care.

Stay tuned for our full comments next Monday, July 3rd.  In the meantime, you may be interested in PCC’s 2022 evidence report Primary Care: A Key Lever to Advance Health Equity, jointly authored with the team at the National Center for Primary Care at Morehouse School of Medicine.

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