Medicaid spending consumes nearly a quarter of Washington’s state budget. Its growing share of state spending, along with the aging of the baby boomer generation, puts the future of healthcare coverage for our elderly, disabled, and vulnerable families at risk.
- Curb waste, fraud and abuse – With its effective Medicaid Fraud Control Unit, Washington should further expand state efforts to investigate and prosecute fraud perpetrated against taxpayers.
- Consumer Engagement – Washington is one of just a few states without meaningful cost sharing for many Medicaid enrollees. Small co-pays and other affordable costs for current and newly eligible participants are proven ways to reduce unnecessary utilization and reward healthy choices.
- Payment Reform – The state’s increasing use of coordinated care in Medicaid is a promising trend. The next frontier must include a systemic shift from volume-based, fee-for-service payments to providers toward paying for health outcomes with shared risk and realigned incentives. We need public-private partnerships which span the health care delivery system (hospitals, doctors, payers and patients) to achieve this goal.
- Delivery System Reform – Washington Medicaid pays for services in a system that is organized around bureaucracies instead of people, resulting in duplication of effort, administrative inefficiencies and poor health outcomes. Significant savings can be achieved through an integrated delivery system designed around the consumer’s interest and needs.
- Federal flexibility – The federal-state funding relationship for Medicaid is a relic of the 1960s. Our state generally receives one federal dollar for every dollar we spend, and only 50 cents on every dollar we save. A per-capita, block grant model that puts Medicaid on a sustainable budget is one way to realign incentives, provide a stable funding source and provide states a legitimate path forward on real innovation, free of unnecessary federal constraints.
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