Medicaid Red Tape Stymies Innovation, States Say

State Medicaid directors say the federal government’s focus on bureaucratic process measures has quashed innovation efforts in the Medicaid program and resulted in inefficiencies and duplications.

“The current policies and procedures bog states down in endless, repetitive reporting and change requests and do not prepare states with the tools Medicaid needs to succeed,” says a report from the National Association of Medicaid Directors.

While the triple aim of better care, better health, and lower costs is often touted by officials at the Centers for Medicare & Medicaid Services as critical to an improved healthcare system, the NAMD report says the current Medicaid program is not structured to meet those goals. “Rather than coordination, health outcomes, program integrity, and efficiency—federal rules have a heavy hand in every aspect of Medicaid programs and remain fixed on process measures.”

Andrea Maresca, director of federal policy and strategy for NAMD, says that instead of a “smooth pathway for states to implement managed care programs or create incentive payment programs,” Medicaid is stuck in a regulatory system that requires time-consuming waivers to effect even the smallest of changes.