SAN DIEGO—Between skyrocketing spending and an administration itching to cut back on "entitlements," Medicaid has had no choice but to undergo a major makeover.
But that makeover isn't necessarily happening at the federal level.
Matt Salo, executive director of the National Association of Medicaid Directors, said during one session at the AHIP Institute & Expo in San Diego that while there are murmurs that congressional Republicans might try to overhaul the Medicaid program, the way states approach waivers to control costs and customize the program is the real overhaul.
Under the Trump administration, states have increasingly sought waivers to modify their Medicaid programs, including through work requirements and funding mental health and opioid treatment services.
"What's happening in the states is much more important than what's happening at the federal level, because that's where the program lives," Salo said. "This is critically important because Medicaid waivers are the way the program is operating and will operate in the future."
Rosmond Dolen, an attorney at Bingham Greenebaum Doll, turned attention to Kentucky's internal battle over Medicaid. She said that Kentucky is struggling to control its Medicaid budget and while expansion led to greater coverage, it didn't necessarily improve health.
"We saw that expanded coverage didn't really mean better outcomes under Medicaid expansion," she said. "Just because you have health coverage doesn't mean you're getting good health outcomes."
She also discussed the federal lawsuit over the state's work requirements, and how the legal battle has led to much uncertainty.
"With this lawsuit, we have to wonder what's going to happen," she said. "We are basically just waiting to see right now."
Kentucky Gov. Matt Bevin has said he would halt expanded Medicaid coverage in Kentucky if the courts stop the work requirements from being implemented. A federal district court is expected to decide on the work requirements sometime this week, but Bevin has also indicated he expects the case to eventually make its way to the Supreme Court.