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The 80 Million Podcast: Daily Summaries Delivered
by Manatt, Phelps & Phillips, LLP
Welcome to The 80 Million Podcast, 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). 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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- 2 weeks ago31 min
The H.R. 1 Implementation Squeeze Is Here
In this episode of The 80 Million Podcast, Manatt Health Senior Managing Director and 80 Million Editor Patti Boozang speaks with Professor of the Practice at Princeton University’s School of Public and International Affairs and State Health and Value Strategies Director Heather Howard and Manatt Health Partner Allison Orris about what H.R. 1 implementation looks like on the ground as states build against a moving target and work to minimize avoidable coverage losses.Authors: Heather Howard and Allison OrrisEditors: Patti Boozang and Amanda Eisenbergtl;dr* Last year’s reconciliation law made unprecedented cuts to Medicaid that will shape the program and our health care ecosystem for years to come. States are building against a moving target even as their implementation efforts are well underway — such as stripping Medicaid coverage from certain lawfully present immigrants as required by H.R. 1 and operationalizing work reporting requirements, more frequent eligibility redeterminations and limits on retroactive eligibility that take effect in January 2027.* States are adapting their systems and policies to major, late-breaking policy changes in the administration’s work reporting requirements rule. At the same time, they are making critical policy and budget decisions as federal rules governing Section 1115 demonstrations, provider taxes, and state-directed payments continue to evolve ahead of key implementation deadlines.* Coverage losses are a major part of the story. Rising uncompensated care and financing changes made by H.R. 1 will also put pressure on Medicaid agencies, providers and state budgets in ways that will be broadly felt beyond people enrolled in Medicaid.* This next year will generate critical evidence. Hard data could take longer but providers will soon see evidence of rising coverage losses and uncompensated care. Other early indicators — most especially enrollees’ experiences navigating new systems — can help policymakers understand how implementation is working in practice.The 80 Million ImpactH.R. 1’s Medicaid changes are arriving in waves, but states are already feeling the cumulative pressure as they prepare to implement various provisions of the law and consider how they will respond to the fallout from rising uninsurance, uncompensated care and budgetary constraints.The law cut nearly $1 trillion in federal Medicaid funding over the next decade, making major structural changes to significant parts of how the program operates. Although some of its biggest provisions do not take effect until 2027 or later — and federal guidance on some provisions is still pending — states have been working to implement these changes at record speed because of tight timelines and high stakes for their enrollees. Getting ready to implement the new Medicaid work reporting requirement in states that expanded Medicaid has garnered significant attention over the last year.There are other near-term changes that states have also been preparing for by updating eligibility systems, communicating with enrollees and providers, and by forecasting how changes will impact their budgets.Beginning Oct. 1, federal Medicaid funding was eliminated for certain categories of lawfully present immigrants. The effects could extend beyond the individuals who lose eligibility. Confusion about the new rules, coupled with new public charge rules, may discourage eligible family members, including children, from enrolling or staying covered. At the same time, the federal matching rate to
- Jul 1, 202636 min
Beyond Coverage — What It Will Take to Fix American Health Care
The Affordable Care Act (ACA) fundamentally changed American health care — expanding coverage, establishing consumer protections that are now broadly expected, and helping cement the idea that access to health care is a basic human need rather than a privilege tied to health status, gender or income. The next challenge is no longer just whether people have coverage, but whether they can afford to get it, keep it and use it. Rising premiums, deductibles, cost-sharing and administrative barriers are straining people across Medicaid, the ACA Marketplaces, Medicare and employer-sponsored insurance. Fixing American health care will require looking across the whole system: reducing friction for patients and providers, rebuilding a durable federal floor for coverage and access, resisting efforts to retreat to a pre-ACA coverage framework, supporting state innovation, and accepting that meaningful reform will require mutual sacrifice across the health care ecosystem. The challenge before us is creating a health care system that is affordable, usable and sustainable for patients, providers, employers and taxpayers alike — wherever they live and whatever their income, gender, race or age. We have a great deal of work to do.
- Jun 25, 202629 min
Paying for Cures — Medicaid’s Next Financing Test
High-cost therapies like cell and gene therapies could transform care for Medicaid beneficiaries with serious conditions, but their upfront prices — often $500,000 to $5 million per patient — do not fit a financing system built around predictable, chronic-care spending. The pressure will only grow as the pipeline expands, eligible populations broaden and treatments become easier to administer. Medicaid’s fixed budgets, enrollment churn and limited data infrastructure make it hard to pay for these therapies at scale or capture their long-term value. Outcomes-based payment and Centers for Medicare & Medicaid Services (CMS) models are important near-term tools, but they are not enough. Durable access will require bolder federal financing solutions such as reinsurance, risk pooling or a dedicated funding stream for transformative therapies. Listen to the full conversation on Spotify, Apple Podcasts, or wherever you get your podcasts to hear Patti Boozang, Terry Cothran and Ross Margulies unpack the promise of curative therapies, the limits of Medicaid’s current financing model and the policy choices needed to make access real.
- Jun 18, 202622 min
America Is Getting Older. Its Long-Term Care System Is Getting Weaker.
Americans are rapidly aging, which is accelerating the demand for the long-term services and supports (LTSS) necessary to their care, as well as the care of a diverse range of children and adults with disabilities. Medicaid is the primary payer for LTSS. Since the early 1980s, that coverage has included home and community-based services (HCBS), which have proven better for health, less expensive and what most people prefer over institutional care. HCBS now make up almost two-thirds of long-term services and support spending, double the rate in 2001. Because HCBS are an optional benefit under Medicaid, states facing fiscal crises can limit access, including through enrollment caps and waiting lists. Today more than 600,000 people are waiting for care across 41 states. With states facing nearly $1 trillion in federal Medicaid funding cuts over the next decade from H.R. 1 and a drumbeat of recent statements from federal leaders questioning the integrity and purpose of HCBS, the fragile infrastructure that keeps people out of nursing homes is at risk — bringing greater urgency to the imperative for change.
- Jun 10, 202629 min
States on the Front Lines — Leading Through Federal Retrenchment
The scale of federal retrenchment is no longer theoretical. In Massachusetts alone, the state is bracing for an estimated $3.5 billion annual loss in federal Medicaid funding once H.R. 1 is fully implemented, against a total Medicaid budget of over $20 billion. Even with aggressive mitigation, the state could still see about 300,000 residents lose coverage. The idea that H.R. 1 simply “right-sizes” Medicaid while protecting the most vulnerable is already breaking down. Children, pregnant women, and people with disabilities are already feeling the effects through fear-driven disenrollment, mounting pressure on rural maternity care, and tighter scrutiny of home- and community-based services. States cannot replace lost federal dollars, but they are not standing still. This episode of The 80 Million Podcast shows how state leaders are investing in trusted, community-based outreach to keep eligible people covered, tackling affordability, shoring up providers and leading through the maelstrom.
- Jun 3, 202638 min
Addressing Social Needs in Medicaid — The Evidence Is In. Now What?
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.
- May 20, 202639 min
AI and Digital Innovation in Medicaid — Promise, Peril and What to Buy
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.
- May 13, 202632 min
Hospital at Home – The Bed Isn’t the Business Model Anymore
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.
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About The 80 Million Podcast
Welcome to The 80 Million Podcast, 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). 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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