Manatt’s Anne Karl loves helping states navigate the Medicaid program because she’s working to improve the country’s health-care safety net.
Her day-to-day is spent thinking about how to use the Medicaid program to better cover individuals, offer more services, and pay for them more efficiently, she said.
Karl has been working with North Carolina since 2017 to completely restructure how its Medicaid program pays over $2 billion in hospital payments each year. The state is transitioning its Medicaid program in July from one where the state pays health-care providers, including hospitals, a fee directly for each service they provide to one where the state pays an insurance company a fixed monthly amount and the insurance company pays the providers.
To change from a fee-for-service to a managed care model this year, the state needed to alter how hospitals were being paid since the existing payment methodology wouldn’t be permitted under federal law, Karl said.
The Manatt partner had to ensure the new managed care payment model complied with the evolving federal requirements and still fit within the state Medicaid agency’s core goals of improving efficiency and quality of care.
“The work that I led for our team was around, ‘Exactly how you do that?’” Karl said. “How do you take the dollars going out today, change it so it fits the federal requirements for the dollars that are going out tomorrow and also advance the policy aims of the agency?”
While Karl’s practice expands beyond Medicaid, she has distinguished herself as an expert on the Medicaid program, which is funded jointly by the federal and state governments.
She not only has substantive expertise in Medicaid, she’s incredibly skilled at working with clients and helping them reach consensus around new ideas, said William Bernstein, a partner and leader of Manatt’s health practice.
“She is a real health-care lawyer,” he said.
Because there’s a lot money involved, Karl said the hospitals were understandably and rightfully concerned about how the Medicaid change in North Carolina, which takes effect July 1, will impact their business.
“It has been a really long collaborative process between working with the Medicaid agency and the hospitals to ensure this big transition will be successful, and most importantly making sure Medicaid beneficiaries in North Carolina get really fabulous care and have great access to that care,” she said.
Karl is also leading Manatt’s work advising Vermont’s Agency of Human Services in developing, drafting, and negotiating an extension of its Medicaid demonstration project, which provides additional subsidies to help Medicaid beneficiaries buy insurance through Obamacare and covers moderate long-term care.
“Vermont has a waiver that goes back to 2005 that does all sorts of innovative things which they need to renegotiate every five years,” she said. “This is the next renegotiation.”
States can request special permission to do things that wouldn’t ordinarily be allowed in the Medicaid program through a waiver under Section 1115 of the Social Security Act. The waiver gives states more flexibility.
At 36, the level at which Karl is operating now in the health-care industry is pretty rare, Bernstein said. “Anne’s just a superstar.”
Like many people, Karl’s work has pivoted over the last year to focusing on the effects of the Covid-19 public health crisis. She’s worked to help her clients better understand how they can utilize the federal and state Covid-19 relief funding for things like covering the costs of traveling nurses or building new testing sites. She’s also been making sure her clients are complying with all the reporting requirements tied to the funds.
“There has been a huge amount of money that’s gone to providers to address the major disruption in terms of their businesses, making sure they have the dollars to keep the lights on and maintain access for individuals,” she said.
“That’s been another huge part of my work in the past year.”