U.S. Sen. Bill Cassidy (R-LA) on Jan. 30 joined federal health officials in announcing the new Healthy Adult Opportunity (HAO) program, which supports states in improving the health of their most-vulnerable Medicaid populations.
The HAO emphasizes value-based care while granting states flexibility to administer and design their programs within a defined budget, according to a fact sheet released by the Centers for Medicare and Medicaid Services (CMS).
“Society has wisely accepted helping to care for those who are less well-off. It is essential that we have the financing to achieve this. We must do things differently in a way that will contribute to better outcomes,” said Sen. Cassidy during the unveiling of the HAO with U.S. Department of Health and Human Services (HHS) Secretary Alex Azar, CMS Administrator Seema Verna, and Oklahoma Republican Gov. Kevin Stitt.
Sen. Cassidy previously spent 25 years as a licensed doctor in Louisiana’s public hospital system delivering care to the uninsured and those on Medicaid, according to his office, which noted that the HAO program is optional and open to states that have expanded Medicaid and those that have not expanded Medicaid.
According to the CMS fact sheet, HAO is limited to adults under age 65 who are not eligible for Medicaid on the basis of disability or their need for long-term care services and supports, and who are not eligible under a state plan. Other very low-income parents, children, pregnant women, elderly adults, and people eligible on the basis of a disability will not be directly affected, CMS says.
The HAO initiative “will allow states to carry out demonstrations under section 1115(a)(2) of the Social Security Act (the Act) to provide cost-effective coverage using flexible benefit designs under either an aggregate or per-capita cap financing model for certain populations without being required to comply with a list of Medicaid provisions identified by CMS,” according to Jan. 30 policy guidance CMS sent to state Medicaid directors.
Under HAO, beneficiaries will maintain all federal due process and civil rights, and HAO demonstrations will be expected to provide minimum benefit standards, eligibility protections and limits on out-of-pocket expenses, says CMS.