National Association of Medicaid Directors
As Prepared for Delivery
Assembly President, Director General Tedros, fellow ministers, and distinguished leaders:
Good morning, everyone. It’s a pleasure to join all of you for this critical conversation.
Let me begin by thanking Centers for Medicare and Medicaid Administrator Chiquita Brooks-LaSure, and CMS Deputy Administrator and Director of the Center for Medicaid and Children’s Health Insurance Program Dan Tsai for their phenomenal leadership.
A cabinet secretary is only as strong as the team around him, and I’m proud to have a remarkable team at CMS and CMCS who are working tirelessly to improve the health and well-being of the American people.
I also want to thank Executive Director Matt Salo and President Jami Snyder, as well as President-Elect Allison Taylor and the entire National Association of Medicaid Directors Board of Directors, and all of our Medicaid leadership in the room for the work you’re doing to save lives and serve communities nationwide.
And of course, I want to recognize the extraordinary leadership of President Biden and Vice President Harris, who have made it their mission to get Americans the quality, affordable care they deserve.
Fifty-six years ago, as President Lyndon Johnson signed Medicare and Medicaid into law, he spoke of the tradition of leadership. He said, “It calls upon us never to be indifferent toward despair. It commands us never to turn away from helplessness. It directs us never to ignore or to spurn those who suffer untended in a land that is bursting with abundance.”
That’s what signing Medicaid into law was all about. And today, more than half a century later, we gather in that same tradition.
Throughout this pandemic, we have witnessed too much despair, suffering, and helplessness. And we cannot turn away. We cannot be indifferent. We must act.
That’s why I wanted to be here myself this morning, because putting health care in reach for as many people as possible is such a priority of the Biden-Harris Administration, just as it has always been for me.
As HHS Secretary, I summarize my priorities this way:
- Ending the pandemic
- Reducing health care costs
- Expanding access to care
- Tackling health disparities
- And strengthening behavioral health.
Medicaid is central to all of these priorities. And that’s why protecting and expanding it is so critical.
But to be successful, we must break down silos and work together at every level. Communication and collaboration are key. Those are more than buzzwords to me. They’re guideposts for success.
States are our partners in delivering the Medicaid program. At the end of the day, all of us are working toward the same goal: How do we get people the services they need?
That question has never been more important, especially as we continue to fight COVID-19.
This pandemic has underscored the vital importance of the Medicaid program.
Medicaid has quite literally been a life-saver for millions of Americans. Over the course of the pandemic, Medicaid and CHIP enrollment grew 14%, from 71 million to roughly 82 million people, the largest single increase in the program’s history.
And let me be clear: The Biden-Harris Administration is committed to keeping all eligible people covered after the public health emergency ends.
There is no doubt that the unwinding process will be complex and difficult. But I assure you that we are going to do this in a thoughtful and measured way. We’re not going to leave people in the lurch, and we are not going to leave our states in the lurch either.
I’m also proud to address you just days after 28 million kids ages 5 through 11 became COVID-19 vaccine-eligible.
This is a pivotal breakthrough in our fight to end the pandemic. And thanks to their rigorous, comprehensive, and independent review of the data, we know that vaccination of younger children against COVID-19 is safe and effective.
To support this new wave of vaccinations, approximately 20,000 trusted providers and convenient sites across the country are offering the vaccine to kids ages 5 through 11, including thousands of pediatricians’ and family doctors’ offices, pharmacies, community health centers, children’s hospitals, community-based sites, and schools. Many of them are doing this in partnership with the people in this room.
We know many families are still trying to decide what is right for them. That’s why we’re continuing to support education and engagement efforts to build public trust. Every week, for example, we work with a network of 16,000+ trusted voices to engage their communities, from physicians to barbers to faith leaders.
We’re also exploring options to support Medicaid pediatricians as they counsel families about the vaccine. One in every three children relies on Medicaid or CHIP, and we know that these providers can play an important role in dismantling disinformation and building trust.
A Vision for Medicaid
Of course, our job today is not just to discuss the challenges we face during this pandemic, but also to articulate a vision for the future of Medicaid – the nation’s largest health insurer.
I tell my team never to be mild. I’m not mild. And I didn’t take this job to be “mild.” I took this job to be “game-changing.”
Our vision for Medicaid should be no exception.
Now what does that mean? In my mind, this means making coverage more accessible, more equitable, and more holistic to meet the needs of every possible family.
Expanding Coverage and Access
Let’s start with coverage and access. Medicaid is a critical pillar of economic security for nearly 1 in 5 Americans. But it’s also out of reach for millions more.
Many Americans are currently eligible for Medicaid but struggle to enroll and stay covered. Those who do maintain Medicaid coverage often do not have the same access to providers and medical services as those with Medicare or commercial insurance.
And 2.2 million people fall into the “coverage gap” – individuals who qualify for neither Medicaid nor the individual Marketplace because of their income level.
That’s why, as part of President Biden’s Build Back Better agenda, we’re focused on expanding Medicaid for more people, and I have urged our HHS team to think about how we can make it easier for people to get and keep coverage.
We won’t stop talking about Medicaid expansion, and we are here to work with you to expand Medicaid in your state if you have not done so yet.
And the Build Back Better plan would close the Medicaid coverage gap, because the Biden-Harris Administration believes that we’ve got to support people now more than ever to get the health insurance they need.
Expanding coverage and access is just the first step. We also must ensure equity. When President Biden took office, he directed all federal agencies to center equity at the core of our work. At HHS, we’re heeding the president’s call.
Take the issue of postpartum care. Maternal mortality in the U.S. is higher than most other developed and high-income countries.
Pregnancy-related mortality for Black mothers is three times higher as compared to White mothers. These disparities persist regardless of education and income level. And we know that many of these deaths are preventable.
Nearly half of all births are covered by Medicaid, and we’re continuing to take bold action to address this crisis.
Through CMS, we’ve helped four states to expand postpartum coverage, giving new parents the critical support that those of us who have built a family know is so important early on. Two of these states now offer postpartum coverage up to one year.
We also want to support and bolster the work of Medicaid in our states by helping to finance the infrastructure we need. For example, in September, we announced nearly $350 million in awards to every state across the nation to support safe pregnancies and healthy babies.
Medicaid is the linchpin to our efforts because Medicaid in it of itself advances equity. It is the health insurance that millions rely on to access the services they need to help them live healthier and better lives.
In the Build Back Better plan, all pregnant people eligible for Medicaid would be assured of continuous coverage for a full year after birth.
We know that ensuring expecting parents have access to continuous coverage is probably one of the single greatest things we can do to close the equity gap for postpartum care, and I look forward to working with all of you to make that happen.
Taking a Holistic Approach to Care
Finally, we’re committed to ensuring that Medicaid is meeting the needs of the whole patient.
For example, Medicaid is the largest payer for behavioral health, particularly for individuals struggling with mental illness or substance use. It’s no secret that the pandemic has exacerbated both.
Roughly 40,000 children have lost a parent to COVID-19, and more than 1.5 million have lost a caregiver.
But it’s more than the numbers. It’s the empty chair at the dinner table or the open seat in the bleachers. It’s the quiet homes and crowded hospitals. It’s not even having the chance to say goodbye.
This tragedy has taken a heavy toll on our young people. According to a recent report by the Centers for Disease Control and Prevention, suicide rates among our nation’s youth have also increased, especially among communities of color.
In fact, both young Black and Hispanic Americans saw double-digit increases in suicide rates last year.
At HHS, we’re not waiting to act. In May, HHS announced $14.2 million from the American Rescue Plan to expand mental health care access that will integrate telehealth services into pediatric care.
We also announced $3 billion for the mental health and substance abuse block grants to states, the largest investment ever in those programs.
And through the American Rescue Plan, we recently awarded $15 million to states for Mobile Crisis Intervention to help some states plan for implementation of a Medicaid mobile crisis benefit -- a benefit that I urge all of our states to take steps to add to their programs.
Substance use has also skyrocketed during the pandemic. In 2020, 93,000 deaths were attributable to drug overdose -- that’s more than double the number of Americans who died in motor vehicle accidents.
Our nation’s behavioral health crisis has gone on far too long. For decades, our society tried to stigmatize and punish those with addiction. But we know the so-called “War on Drugs” was actually just a “War on People.”
That’s why last month, we rolled out a strategy that changes course and gives people the help they need.
Our new HHS strategy aims to prevent all overdoses. Instead of stigma and blame, we’re focused prevention and recovery, harm reduction and evidence-based treatment.
And everything we’re doing is guided by our commitment to equity and compassion. Medicaid is central to that strategy, and I want to recognize again the incredible team at CMS working with our HHS Divisions and across the government to advance our goals.
Medicaid is also working with some states to cover health-related social needs with Medicaid funding, such as nutrition and housing, because we know that people don’t experience health in a vacuum – it’s also a reflection of one’s lived experiences.
And the Build Back Better framework will permanently improve Medicaid coverage for home care services for seniors and people with disabilities.
This represents the most transformative investment in access to home care since these services were first authorized for Medicaid 40 years ago.
It’s that collaboration and partnership that will make us successful. Again, my goal is to break down those silos between our programs so that we can focus on the people.
This is only a snapshot of the work we’re doing around Medicaid and across our Department. But the trains don’t run without you. We need you. We need your leadership. We need your resolve. And most of all, we need your partnership.
Make no mistake: If you’re here to do good things for people, we’re here to work with you.
COVID-19 hasn’t just forced us to think outside the box. It’s thrown the box out the window. And we need to work together on creative and innovative solutions to get families the care they need.
Because that’s what our work is all about – not just programs, but people. Not just dollars, but dignity. Not just numbers and figures, but names and faces. They are counting on us to succeed.'
I like to tell folks: the Department of Health and Human Services is aptly named – you can’t separate health from humanity. If we lead with our humanity, there’s nothing we can’t do for the American people.