Proposed Changes to Medicaid Access Rule Would Undermine Access to Care

CMS published proposed changes to the Medicaid Access Rule in the Federal Register on March 23 that would have a far-reaching impact on Medicaid beneficiaries and providers. Now that we’ve had time to analyze how the proposed changes would impact children, families and others who rely on Medicaid to meet their health care needs, we would like to share our findings and encourage you to submit your own comments by the May 22 deadline.

Our in-depth analysis of the proposed changes finds they would be particularly troublesome for about 3.9 million Medicaid enrollees (including 660,000 children) living in 18 states. If this rule is finalized, these 18 states would no longer have to document or monitor access to care in fee-for-service Medicaid.

Access to care for Medicaid beneficiaries would also be at risk in the remaining states. Payment to fee-for-service providers could be cut without a full consideration of the impact on beneficiary access. In fact, the way the proposed changes are drafted, they would allow states to deeply cut provider payments for EPSDT screening services without being required to explain the potential effect on access to care.

The current Medicaid Access Rule was issued in November 2015 after years of litigation. The purpose of the Rule is to give CMS the information it needs to determine whether state Medicaid programs are complying with the statutory “equal access” requirement – i.e., that payments to providers are “sufficient” to ensure that Medicaid beneficiaries have access to covered services comparable to that of people with other types of coverage who live in the same geographic area. Among other things, the Rule required that, if state Medicaid agencies want to cut payment rates to fee-for-service providers, they must submit information to CMS on the likely effects of the cuts on access to care. By undermining these important protections, this rule would put access to care for children and families at risk.

We urge CMS to withdraw this flawed proposal. The current Medicaid access rule should be strengthened not gutted.

Access Rule Comments

Andy Schneider is a Research Professor at the Georgetown University McCourt School of Public Policy.