AHIP's wish list for Medicaid, MA under Trump

America's Health Insurance Plans has several suggestions for Donald Trump's administration when it looks to implement new policies for Medicaid and Medicare Advantage. (Getty/GooDween123)

As Republicans prepare to assume control of both the White House and Congress, America’s Health Insurance Plans has a clear message for them: Be careful when making changes to Medicaid and Medicare Advantage.

The health insurance industry trade group outlined its recommendations, which call for thoughtful policy changes and increased stakeholder input, in a document emailed to FierceHealthPayer Wednesday. It also offered proposed policies to keep the individual markets stable amid a likely repeal of the Affordable Care Act.

A smooth Medicaid transition

Donald Trump has indicated he wants to convert Medicaid funding to block grants, and his pick for the head of the Centers for Medicare & Medicaid Services, Seema Verma, is expected to encourage more leeway in how states design their Medicaid expansion programs.


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But AHIP points out that the Medicaid managed care final rule published this spring already contains “far-reaching changes” for Medicaid health plans. Given that, AHIP says the new administration should work with stakeholders to identify which new rules or policy changes might need to be delayed during that transition.

Along the same lines, the group notes that if policymakers want to enact a new financing system by 2019, they must develop it far enough in advance to give states and health plans time to analyze and budget for reforms. And if the new administration changes the rules for Medicaid expansion, those regulations should ensure a smooth transition for both states and consumers.

Looking ahead, policymakers should ensure that any new Medicaid financing system is actuarially sound and builds in flexibility for state programs to innovate in how they address “certain social determinants that are core drivers of health costs for Medicaid populations,” according to the document.

More input in Medicare Advantage policies

AHIP says its immediate priority is to ensure favorable provisions in the draft 2018 rate notice and call letter for MA and Part D plans, set to be released in February. Echoing its recommendations for Medicaid, AHIP says no new program requirements should be imposed on MA or Part D plans for 2018 in order to avoid increasing costs for plans, providers and beneficiaries.

AHIP also says the 2018 draft notice should stop CMS’ planned transition toward using "encounter data" as the source of diagnosis for calculating MA plans’ risk scores, saying this approach will effectively lead to a rate cut.

The group further requests that the new administration follow the health insurance industry’s suggestions for how to improve the star rating system, such as excluding quality bonus payments from an ACA-imposed cap on MA benchmark rates, as well as stopping the practice of using audit findings and compliance actions to adjust quality measures.

Finally, AHIP urges the incoming policymakers to implement “significantly longer timelines and enhanced processes for input” from stakeholders when designing changes to risk adjustment and other key areas of the MA program.

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