Strengthening the Safety Net for Millions of Americans
On April 27, 2023, the Centers for Medicare & Medicaid Services (CMS) announced a comprehensive set of proposed regulations aimed at enhancing access to care, improving service quality, and promoting equity in the Medicaid and Children’s Health Insurance Program (CHIP) systems. These proposed changes represent one of the most ambitious federal efforts in recent years to reform public health coverage for the more than 90 million Americans who rely on Medicaid and CHIP.
CMS Administrator Chiquita Brooks-LaSure stated that the proposals were driven by a commitment to making sure these programs “deliver high-quality care with transparency, accountability, and equity at their core.”
Key Components of the Proposed Rules
The proposed regulations center around three major goals: increasing transparency, standardizing quality measurement, and improving oversight of managed care operations. The updates are designed to ensure that beneficiaries—especially vulnerable and underserved populations—have timely, equitable access to the care they need.
1. Enhanced Oversight of Managed Care Programs
- CMS seeks to implement more rigorous monitoring of Medicaid managed care organizations (MCOs), which now serve over 70% of all Medicaid beneficiaries.
- The proposed rule would require MCOs to meet minimum appointment wait time standards, regularly submit network adequacy reports, and provide real-time provider directories.
- States would also be required to review and validate access metrics, ensuring that provider networks are not just robust on paper but functional in practice.
2. Standardized Quality and Performance Metrics
- The proposal mandates the use of nationally consistent quality measures, allowing stakeholders to compare outcomes across states and plans.
- CMS would require annual public reporting on key performance indicators, such as patient satisfaction, health outcomes, and equity benchmarks.
- This standardization is designed to improve transparency and drive data-informed policy decisions.
3. Improved Beneficiary Engagement and Feedback
- CMS emphasizes the importance of engaging Medicaid and CHIP beneficiaries through structured feedback mechanisms.
- States would need to establish and maintain beneficiary advisory councils, with a particular focus on including voices from historically marginalized communities.
- The goal is to ensure that program design and oversight reflect real-world experiences of enrollees and respond effectively to their concerns.
Addressing Health Equity
A central theme of the proposed rules is advancing health equity—a top priority of the Biden administration’s broader health agenda. CMS explicitly highlighted the need to close gaps in access and outcomes for racial and ethnic minorities, people with disabilities, rural populations, and non-English-speaking communities.
To that end, the rules include:
- Requirements for language accessibility in member materials and provider communications.
- Expanded collection and reporting of demographic and social determinants of health (SDOH) data.
- Strategies to improve culturally competent care through provider education and performance monitoring.
A Broader Strategy for Medicaid and CHIP Modernization
The proposals come at a critical moment for Medicaid and CHIP, as states begin unwinding pandemic-era continuous coverage protections, potentially leading to coverage disruptions for millions. CMS aims to use this regulatory opportunity to not only shore up the integrity of managed care but also to elevate service delivery standards.
Healthcare advocates have welcomed the proposals as a much-needed step toward modernizing two of the country’s most vital safety-net programs. At the same time, stakeholders—including state Medicaid agencies and managed care providers—have begun reviewing the operational implications and preparing formal comments during the public feedback period.
Next Steps and Public Comment
CMS will open a public comment period for stakeholders to provide input on the proposed rules. Feedback from state governments, healthcare providers, patient advocacy groups, and the general public will be used to finalize the regulations in the months ahead.
If adopted, these changes would be implemented gradually, giving states time to adjust and align their systems with federal expectations. The proposals reflect CMS’s growing focus on accountability, quality, and person-centered care in Medicaid and CHIP programs.
Source:
Alston & Bird – Health Care Week in Review: CMS Proposes Medicaid and CHIP Reforms
