The Trump administration unveiled a new “scorecard” this week that will rank how states’ Medicaid populations are faring on everything from vaccinations to blood pressure to mental health care. Though the data currently available is several years old, the scorecard has the potential in the future to shine a light on the true impact of measures like Medicaid work requirements, which health advocates and researchers predict will slash insurance coverage without improving people’s health or incomes.
In other words, the Trump administration’s new push for transparency could, if done in good faith, reveal the negative effects of the dramatic policy changes to Medicaid that the administration is promoting.
Since taking office, the Trump administration has approved four states to implement Medicaid work requirements — which were never before allowed in the program’s 50-plus-year history. At a briefing with reporters Monday, Seema Verma, the administrator of the Centers for Medicare & Medicaid Services, said eight more states are “in the queue” for permission to put work requirements in place. As the online scorecard program moves forward, she said she hopes to collect and share data both from states with Medicaid work requirements and those without them, to allow the American people to hold states and the Trump administration “accountable” for such policy changes.
“As we’re looking at able-bodied adults, that might be a measure we start looking at: how many individuals are engaged in work, how many of them are in training or in school? Those are the things that that we’ll look at in the future,” she said. “When you have transparency, there’s going to be accountability.”
When it comes to accountability for the restrictive Medicaid policies Verma is currently approving at a rapid clip — not only work requirements but premiums, benefit cuts, etc. — advocates and health care experts say, “Bring it on.”
“It is going to show I think, that states that invest in programs like Medicaid have much better health outcomes than states that don’t, and that red states are less healthy than blue states,” said Robert Kraig, the executive director of Citizen Action of Wisconsin, a group challenging Gov. Scott Walker’s proposed Medicaid waiver. “The whole right wing vision of shrinking government to a size where you can drown it in a bathtub, I think the data will not show that that is effective.”
Though the data currently available on the site is a few years old, and thus does not yet show the impact of Trump administration policies, the Medicaid scorecard is revealing some of those disparities.
Out of the states that reported data, Louisiana had the lowest rate of adequately treating Medicaid enrollees diagnosed with high blood pressure, 26 percent, while Rhode Island had a high of 72 percent. The rate of women receiving postpartum checkups ranged from just 21 percent in Oklahoma to 74 percent in Rhode Island. And the rate of children between the ages 3 to 6 enrolled in Medicaid and CHIP who receive adequate medical care varied from 48 percent in Idaho to 86 percent in Massachusetts.
In the future, data that reveals that work requirements are ineffective or lead to reduced coverage and worse health outcomes could even be cited in future lawsuits challenging the Medicaid waivers.
The focus on transparency in Medicaid comes just a few months after a scathing report from the Government Accountability Office that said CMS has been so bad at collecting data that it is impossible to tell whether the Medicaid waivers they’ve been approving have improved health care or saved states money. Often, the report said, the federal government renews Medicaid waivers without first reviewing whether or not the first iteration was successful.
Leonardo Cuello, the director of health policy at the National Health Law Program, told TPM that the new Medicaid scorecard is a huge step towards remedying this problem, but he fears the data will be collected and presented in a misleading way to further the administration’s pro-work requirements agenda.
“More data is a good thing, but they presumably are going to look for evidence that helps them,” he said. “Let’s say it’s the case that in the states where they do the work requirement, they find a 1 percent increase in people having a job. How can you separate out the work requirement’s effect from the broader economic picture? And what else are they measuring? Are they going to track how many people don’t apply for Medicaid because of the requirement? How many terminated from the program? Are you measuring just the result you’re looking for or are you really looking at how this effects people?”
The National Association of Medicaid Directors is also highly skeptical of the new scorecard. In a statement released on Monday, the group said the new scorecard is “problematic.”
“There are significant methodological issues with the underlying data, including completeness, timeliness, and quality of the data,” NAMD wrote. “Until these fundamental variances are addressed in the Scorecard, it will not be possible to make apples-to-apples comparisons between states.”
Verma hit back in a statement Tuesday, chiding the group not to “let the perfect be the enemy of the good.”
Response to NAMD Statement on CMS’s first-ever Medicaid Scorecard pic.twitter.com/kylpnmtSOB
— Administrator Seema Verma (@SeemaCMS) June 5, 2018
Because states can currently refuse to participate in the scorecard without any ramifications, the data up on CMS’ site is riddled with holes. In fact, not one of the 17 health measures in the scorecard compares data from all 50 states and DC. But Verma said she hopes they’ll feel “compelled” to send in their statistics going forward. And if they don’t, she says it is “possible in the future” that the data reporting will be mandatory or incentivized.