CMS Releases Medicaid Block Grant Plan: ACG Reviewing Impact to GI

From ACG Legislative and Public Policy Council Chair, Whitfield L. Knapple, MD, FACG

The Centers for Medicare and Medicaid Services (CMS) on Thursday released a plan to let states convert a portion of Medicaid funding into block grants, a politically sensitive subject but long-desired goal among the Trump Administration and other health policy officials. CMS Administrator Seema Verma encouraged state Medicaid directors to request federal payments to cover low-income adults, and also to use block grants as a way to constrain costs. According to the proposal, states who voluntarily cover adult populations under the Affordable Care Act (ACA) could also receive capped funding. State Medicaid programs would also have new ability to limit health benefits and drugs. States could choose to receive lump-sum funding or receive funding based on the number of enrollees. Medicaid covers about 1 in 5 low-income Americans. Except for Puerto Rico, the federal government has long provided open-ended matching Medicaid funds to states.

Democrats and other health policy officials have already voiced their opposition to CMS’ proposal. Policy wonks also anticipate legal challenges to CMS’ new proposal, possibly alleging that CMS does not actually have the authority to unilaterally cap Medicaid program spending. The ACA's section on Medicaid expansion remains popular in Congress. Of note, Congress rejected a Medicaid block grant program in 2017, when it was debated during efforts to repeal and replace the ACA. According to the Kaiser Foundation, 37 states (including D.C.) have expanded Medicaid pursuant to the ACA and 14 states have not adopted the expansion.

Governors from Oklahoma and Alaska have expressed support for the proposal. Tennessee, which hasn't expanded Medicaid, became the first state to formally request a block grant for its program, although Tennessee’s request is broader in scope than this new CMS proposal. While this new policy may give states greater power when negotiating drug prices, CMS had told Massachusetts in 2018 that the state could create a limited drug formulary, but would have to forfeit mandatory discounts drug makers provide in exchange for states agreeing to cover all medicines.

ACG is currently reviewing the proposal to determine the impact to GI and our patients.

New! ACG Practice Management Toolbox Article: Negotiation 101: How to Get What You Want in a Negotiation

New this week is a podcast to the accompanying article, "Negotiation 101: How to Get What You Want in a Negotiation". Dr. Vonda Reeves, MD, MBA, FACG and Dr. Sameer Islam, MD, MBA, FACG explore how to negotiate effectively for your practice.

Click here to read the article.

Click here to listen to the podcast.

Attention ACG Virginia Members: Tell Your State Senators to Oppose S.B. 1026

ACG and the Virginia Gastroenterological Society (VGS) are urging members to voice opposition to Senate Bill No. 1026. This bill would allow a pharmacist to prescribe, dispense, and administer drugs and devices for the treatment of conditions, including Helicobacter pylori (H. pylori) bacteria. Tell your Virginia state Senators to oppose Senate Bill No. 1026!

Remember to contact your ACG Governor on important state and local issues impacting you and your practice.

The ACG Board of Governors is one of the most unique aspects of the American College of Gastroenterology. Governors are ACG Fellows that are elected from the membership of a particular state or region. There are currently 77 Governors across seven different regions in the U.S. and abroad. The Board of Governors acts as a two-way conduit between College leadership and the membership at-large. This helps the College make certain it is meeting the evolving needs of the membership.

What is the Practice Management Toolbox?

Gastroenterologists in private practice find themselves working in a time of unprecedented transformation. Pressures are high as they make important management decisions that profoundly affect their business future, their private lives, and their ability to provide care to patients. The ACG Practice Management Committee has a mission to bring practicing colleagues together to explore solutions to overcome management challenges, to improve operations, enhance productivity, and support physician leadership. It was in this spirit that the Practice Management Toolbox was created.

The Toolbox is a series of short articles, written by practicing gastroenterologists, that provide members with easily accessible information to improve their practices. Each article covers an issue important to private practice gastroenterologists and physician-lead clinical practices. They include a brief introduction, a topic overview, specific suggestions, helpful examples and a list of resources or references. Each month a new edition of the Toolbox will be released and will then remain available here along with all previous editions. The Practice Management Committee is confident this series will a provide valuable resource for members striving to optimize their practices.