White House proposes new national Medicaid standards

The Obama Administration rolled out new rules for the Medicaid and Children’s Health Insurance Program on Tuesday, setting national standards for quality and performance of private insurers participating in the federal-state partnered program. The rules are designed to level the playing field throughout the 50 states to help, “ease the administrative burden on insurers and regulators”.

Centers for Medicare & Medicaid Services (CMS) administers federal health insurance programs for the poor and the elderly, within the Department of Health and Human Services. The proposed CMS rating system for Medicaid insurers (already used for Medicare plans) would measure “clinical quality management, member experience, and plan efficiency.”

Some say the proposed changes (subject to a public comment period) are long overdue. 60% of Medicaid recipients are covered under private plans today, compared to only 8% less than 25 years ago.

The new CMS rules for Medicaid are expected to be met with some resistance from the States, and even some of the insurers themselves, which have had room to administer the program as they see fit and adopt many of their own business practices. Proponents, however, argue that the new standards will reduce overall costs and improve the quality of care for patients.