Medicaid Principles – The Partnership for Medicaid

The Partnership for Medicaid is a nonpartisan, nationwide coalition made up of organizations representing health care providers, safety-net health plans, counties, and labor. The 23 members of the Partnership for Medicaid are strongly committed to the Medicaid program, which plays a vital role in delivering necessary health care and other related services and supports to the nation’s most vulnerable citizens.

In addition to being a major source of funding for a variety of essential health services delivered in communities across the country, Medicaid is vital to the financial stability of safety net providers.

The Partnership is committed to the Medicaid program’s foundation as a federal-state-local partnership and to its role in delivering high-quality, efficient, and cost-effective care to millions of Americans. We stand ready to work with policymakers to identify new and innovative strategies to strengthen Medicaid and improve on its promise of providing high-quality coverage and access to care for populations in need.

As lawmakers consider ways to reform Medicaid, the Partnership is united behind the following core set of principles:

Meaningful Coverage

Medicaid beneficiaries deserve secure and stable access to health coverage. Federal and state governments should take steps to maintain continuous enrollment of eligible individuals and minimize harmful eligibility churn.
Medicaid benefits should be robust enough to meet the needs of beneficiaries. Federal and state financing of Medicaid-covered services should be sufficient to ensure that all Medicaid enrollees have timely access to high quality, necessary care.
Participation in Medicaid or the ability to access health services under Medicaid should not be cost-prohibitive. Federal and state governments should limit cost-sharing on Medicaid program beneficiaries.
Medicaid must be accessible to people in times of need. Federal and state government should, at a minimum, maintain current eligibility standards and strengthen the ability of Medicaid to provide and maintain coverage during an economic slowdown.
Changes to Medicaid eligibility and benefits should balance state flexibility and innovation with necessary federal standards. The federal government must deploy oversight to protect patients from harmful eligibility and benefit reductions.

Sustainable Financing

Medicaid policy changes should avoid shifting costs onto states, local governments, providers, and beneficiaries. Federal and state governments should recognize the complexity and variation of Medicaid financing methodologies and minimize potential adverse unintended consequences of cost shifting. To ensure financing sustainability, the Partnership opposes federal efforts to turn Medicaid into a block grant or voucher, or to otherwise place a spending cap on the program.
Medicaid payment rates to providers must be sufficient to guarantee participation in the program. Federal and state governments should set Medicaid payments rates at levels that are consistent with rates paid under Medicare, which are designed to account for the total cost of providing care.
Changes to Medicaid should strive for sustainable programmatic improvements, not solely short-term fiscal objectives. Federal and state government should safeguard against harmful cuts to the program.

Effective Administration

Medicaid must remain a reliable source of health coverage that bolsters the safety net. Federal and state government should ensure that changes to the program include adequate safeguards to ensure the longevity and viability of the Medicaid program for beneficiaries, providers, and states.
Medicaid policy changes should consider public input. Federal and state government should work to improve and simplify administrative functions and ensure transparency and stakeholder engagement in the process.
State flexibility to make changes to the Medicaid program – including through Section 1115 waivers – must be balanced with federal oversight and deference to federal law. Federal and state governments must always seek to promote the objectives of the Medicaid program and to be in compliance with the Medicaid statute.

Quality and Innovation

Medicaid should support the provision of equitable, collaborative, patient-centered care. Federal and state governments should promote the continued innovation of health care delivery and consider both public- and private-sector solutions while protecting essential benefits and access to care for beneficiaries.
Payment and delivery system innovations that require substantial investment in new technologies and resources should take into consideration the costs of implementing these changes and should be supported with appropriate federal investment. Any program to pay providers based on quality of care or efficiency should be developed collaboratively, involve all stakeholders, recognize differences across individual providers and the beneficiaries they serve, and ensure adequate transition planning and implementation time.
Medicaid programs should participate in comprehensive quality measurement and reporting programs. Federal and state governments should create a consistent, standardized method of measurement and reporting with appropriate risk adjustment methodologies while also promoting improvement in quality of care.

Commitment to Achieving Health Equity

Medicaid programs should work to identify and dismantle sources of structural racism within the health care safety net. Federal and state governments should identify and address any programmatic biases that perpetuate structural racism or health inequities experienced by marginalized communities.
Medicaid programs have the responsibility of delivering high-quality, accessible, affordable, evidence-based health care to all – regardless of their socioeconomic background, disability, race, citizenship status, sexual orientation, gender identity, housing status, employment status or involvement in the justice system – for the attainment of the highest level of health for all people.
Investments in Medicaid should focus on addressing health equity. Federal and state governments should include financing pathways and incentive payments to improve health equity and address the social determinants of health among beneficiaries.

June 2021