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by Manatt, Phelps & Phillips, LLP
Welcome to The 80 Million Podcast, powered by Manatt Health and hosted by Patti Boozang. Think of us as the proverbial water cooler where you can listen to health care policy discussions particularly focusing on federal and state Medicaid policy, and the potential impact on your organization — whether you’re part of government, a provider system, health plan, life sciences company or another organization within the health care ecosystem that Medicaid touches. Our Substack blog and podcast will feel like talking to your smartest friend (who happens to be deeply entrenched in Medicaid). Subscribe for notifications about new episodes, review our The 80 Million blog and find more information on our services at manatt.com. The views expressed on the podcast reflect the personal views and opinions of the participants and are not intended to constitute legal advice or counsel, nor the views of Manatt Health. Credits: Host and Executive Producer: Patti Boozang, Senior Managing Director, Manatt Health Editorial Director: Amanda Eisenberg, Consultant, Manatt Health Editor: Anthony Vito
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The evidence that addressing social needs like food and transportation improves health outcomes and reduces Medicaid costs is no longer theoretical. We’ve seen recent data from two efforts: North Carolina’s Healthy Opportunities Pilots (HOP) generated $164 in savings per member per month, according to a new, multiyear evaluation of 31,000 Medicaid enrollees by the Sheps Center at University of North Carolina. The Centers for Medicare & Medicaid Services (CMS) Accountable Health Communities model showed 3%–4% reductions in total cost of care through screening and navigation alone. Payment remains a major structural barrier. Most of this work — outreach, navigation and coordination — has no billing code under fee for service. Scaling requires value-based arrangements with real teeth, not the “value veneers” that occupy value-based care real estate without changing care delivery. Waymark, a Medicaid-focused care delivery company, addresses this by pairing AI-enabled community-based care teams with value-based contracts designed to measure impact and align payment with proven intervention. States don’t need to wait for federal action. Managed Medicaid contracts allowing for accountable programs that meet social and clinical needs, using in-lieu-of services authority, and directing rural health transformation dollars toward this infrastructure are all available now. Still, permanent scale will require Congress to move this work from waiver territory into the core Medicaid benefit. Rajaie Batniji, Patti Boozang and Mandy Cohen explore what the latest evidence on addressing social needs in Medicaid means for policy and practice in this week’s 80 Million Podcast. The discussion examines why the case for action is stronger than ever, what it takes to scale these interventions, and where states can move now.
State Medicaid programs are under extraordinary pressure as they navigate federal funding uncertainty, H.R. 1 implementation, and health care cost growth that consistently outpaces both inflation and state revenue growth. States have myriad technology vendors pitching solutions to help alleviate those burdens, particularly around helping drive down the costs associated with certain clinical conditions and administrative functions. These technology solutions, increasingly, are AI powered and promise to be the differentiator for patients and Medicaid budgets alike. It can be daunting for state Medicaid leaders to evaluate which technologies deliver, where there are risks, and the types of structural changes that are needed for innovation to benefit the people Medicaid serves rather than the vendors selling to it. In Episode 3 of The 80 Million Podcast, host and 80 Million editor Patti Boozang speaks with Caroline Pearson, executive director of the Peterson Health Technology Institute (PHTI), and Jared Augenstein, senior managing director at Manatt Health, about what Medicaid leaders should believe — and question — about the explosion of artificial intelligence (AI) and digital health solutions entering the market.
Innovate or die: That’s the conversation health systems are having as they navigate tightening finances due to new federal policy in Medicaid, including H.R. 1, a national health care affordability crisis, rising patient acuity and a workforce depleted by burnout. Hospital at Home may signal a paradigm shift among hospital systems driven by “losing less money.” That’s good news for Medicaid. 80 Million Editor Patti Boozang sat down with UMass Memorial Health CEO Dr. Eric Dickson and Manatt Health’s Tom Robertson to explore what real innovation looks like in a hard operating environment.
Medicaid, which is jointly funded by states and the federal government, has always operated under pressure, but this moment feels different. The program is facing a unique period of change, defined by factors that are significant on their own but far more consequential together. Centrally, the 2025 health care cuts to Medicaid and beyond, to the tune of $1 trillion over the next decade, will add nearly 10 million people to the uninsured ranks. These cuts will also trigger state budget holes and new funding gaps for the nation’s health care safety net. The funding cuts are compounded by new administrative burdens for consumers because of new Medicaid work reporting requirements and other red-tape hoops people will need to jump through to get and keep coverage. Paperwork is a tried-and-true method for reducing enrollment, undermining decades of bipartisan efforts to streamline enrollment while ensuring program integrity through data-driven verification of eligibility. State Medicaid agencies will also feel the pinch as they operate with steep new administrative costs and fewer resources, and health providers who continue to serve low-income populations will be faced with patients churning in and out of coverage and a rise in uncompensated care. The “old Medicaid rubric” doesn’t make sense anymore. It’s one that we’ve moved beyond for good reason through the Affordable Care Act expansion. The vast majority of Americans support and value their Medicaid coverage, including their expansion coverage, as vital to keeping their families safe, healthy and financially secure.
For those of us at The 80 Million, our name represents a vital segment of the American population — nearly one-fifth of the nation — who rely on Medicaid for their health, financial security and in some cases, survival. Today, the program stands at a critical inflection point. As Medicaid faces what many policy experts consider its most significant existential threat since its inception, we are expanding our coverage to meet the moment. Starting May 6, we are launching a special eight-episode podcast series to explore the seismic changes reshaping Medicaid and health care access more broadly in our country. Hosted by Senior Managing Director Patti Boozang, Season 1 of The 80 Million Podcast is about what's at risk at this moment in Medicaid, fiscally, operationally and politically, and where the program needs to adapt deliberately — not just to survive, but to get stronger. This is a time that demands solutions. Over the next decade, Medicaid is expected to see nearly $1 trillion in federal funding cuts from H.R. 1, new administrative hurdles that make getting and maintaining Medicaid coverage difficult, and federal policy shifts that limit the ability of states to raise revenue through state-directed payments and provider taxes. This new series reflects the very best of what defines our health group — deep expertise, meaningful collaboration and a commitment to shaping the future of care for the 80 million Americans who rely on Medicaid. Across the season, Patti brings together colleagues from Manatt Health and nationally recognized leaders to explore the most pressing challenges and opportunities facing the program today. Produced by Amanda Eisenberg, The 80 Million Podcast digs into technological innovations, FWA, and the operational and fiscal tradeoffs states are facing right now. Subscribe to The 80 Million here. Episodes will be available starting May 6 where you get your podcasts and, for subscribers, in your inbox each week!
Welcome to The 80 Million Podcast, powered by Manatt Health and hosted by Patti Boozang. Think of us as the proverbial water cooler where you can listen to health care policy discussions particularly focusing on federal and state Medicaid policy, and the potential impact on your organization — whether you’re part of government, a provider system, health plan, life sciences company or another organization within the health care ecosystem that Medicaid touches. Our Substack blog and podcast will feel like talking to your smartest friend (who happens to be deeply entrenched in Medicaid). Subscribe for notifications about new episodes, review our The 80 Million blog and find more information on our services at manatt.com. The views expressed on the podcast reflect the personal views and opinions of the participants and are not intended to constitute legal advice or counsel, nor the views of Manatt Health. Credits: Host and Executive Producer: Patti Boozang, Senior Managing Director, Manatt Health Editorial Director: Amanda Eisenberg, Consultant, Manatt Health Editor: Anthony Vito
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