Matt Salo on Medicaid Differences Across States

Because Medicaid programs are so diverse from state to state, expansion may not cause such a radical departure from the current status, says Matt Salo, executive director of the National Association of Medicaid Directors.

Transcript (slightly modified)

What is the challenge of working with different states that may be in different stages of expanding Medicaid?

I think the irony is that it’s really no different than it has historically been. And one of the misperceptions about Medicaid is that it has always been one way, and then post-expansion it’s a different way. When in fact historically, since 1965, 50 state Medicaid programs have in fact looked quite different from one another.

While there’s a broad federal framework of who states must cover, what services they must provide, and basic parameters on how to structure and pay for things, there’s always been enormous state flexibility in moving around the edges and deciding, well who else do you want to cover? What other services do you want to provide? How do you want our organized care differently? Whether that’s managed care, whether that’s thinking about alternative approaches to nursing homes for people who need long-term care. Medicaid programs have traditionally looked very different from one another. Our job is to help each of them in whatever they’re doing, no matter how different they are.