« The Dual Agenda: April 6, 2016 Issue

State Highlights

Alabama

The stand-off  between the Alabama state Legislature and Governor Robert Bentley over the future of the state’s Medicaid program continues, with the governor recently suggesting establishing a state lottery to pay for Medicaid. As it did last year, the Legislature has passed a budget that guts the state’s Medicaid program, including the funding for the innovative Medicaid reform program recently approved by the Centers for Medicare and Medicaid Services. A special session later in the year is a virtual certainty to resolve the conflict.

California

The California Department of Health Care Services will host a webinar on April 7 to discuss a number of proposed program changes aimed at strengthening the quality of care and promoting sustainable enrollment in Cal MediConnect, the state’s dual eligible demonstration project.

In related news, Justice in Aging has published several new tools on key legal protections for Cal MediConnect enrollees. These include a fact sheet on maintaining eligibility and a toolkit on preventing balance billing.

Colorado

The Colorado attorney general has approved the first-in-the-nation conversion of a nonprofit PACE (Program of All-Inclusive Care for the Elderly) provider to for-profit status. As a PACE provider, InnovAge serves dual eligible beneficiaries over age 55 who require a nursing home level of care. Among the conditions of conversion imposed by the attorney general were:

Colorado consumer advocates participated fully in the public review of the proposed conversion, and though they impacted its ultimate outcome, they remain concerned about the implications of the transaction on the affected communities.

Connecticut

A recent Wall Street Journal article (subscription required) reported on the success of Connecticut’s “managed fee-for-service” program serving Medicaid beneficiaries throughout the state. According to the article, the program has resulted in reduced monthly costs per patient, increased doctor participation and reduced administrative costs. Connecticut shifted away from managed care and to the new managed fee-for-service program in 2012.    

Illinois

The Illinois Department of Healthcare and Family Services released updated enrollment numbers for the state’s three Medicaid managed care coordination programs: the Integrated Care Program, the Medicare-Medicaid Alignment Initiative and the Family Health Plans/ACA Adults Enrollment. In all, over two million beneficiaries are enrolled in across the three programs.

Maryland

The Hilltop Institute at the University of Maryland, Baltimore County published two new studies on Maryland’s dually eligible population. One study looked at hospital stays among dual eligibles and found that just over 5 percent had three or more hospital stays in 2012. A second study indicates that 6 percent of those hospital admissions involved treatment for psychosis. This series of studies is being produced amid anticipation of the state’s efforts to move forward with a reform program for the dually eligible population.

Massachusetts

The Commonwealth’s Health Policy Commission has issued a sobering report on the state of community hospitals in Massachusetts. The report identifies significant and rapid changes to the health care system as well as persistent market dysfunction in the state’s hospital industry as causes of severe strain on the state’s community hospitals. The industry is dominated by a few large provider systems anchored by large academic medical centers or teaching hospitals. Strains on community hospitals have already resulted in service reductions and even hospital closures.

MassHealth, the state’s Medicaid program, is conducting a live webinar to support providers, plans and others in their work with One Care, the Massachusetts dual eligible demonstration project. Health Activation: Engaging People in their Care, will be held on Thursday, April 28 at 12 – 1 p.m. The webinar will describe both clinician and peer-oriented approaches to engaging One Care enrollees in their own care. Those interested must register for the webinar.

Michigan

The Michigan Department of Health and Human Services issued 60-day notices to approximately 12,000 dual eligible beneficiaries alerting them that they will be passively enrolled on June 1 into MI Health Link, the state’s dual eligible demonstration project. These beneficiaries are those who became newly dually eligible during the past year. A newly released dashboard shows that there are currently 32,535 people enrolled in MI Health Link.

Minnesota

Community groups in Minnesota are working to develop policies, frameworks and priorities that position racial justice as the core objective for Minnesota’s Legislature to address. In an effort to push for action on disparities from the state Legislature, Voices for Racial Justice, an organization working to advance racial, cultural, social and economic justice in Minnesota, recently released its 2016 Racial Equity Agenda. The agenda includes recommendations for making healthy communities a priority, including removing barriers that exist to optimal health outcomes, such as inadequately stratified data collection and analysis, and the delivery of culturally appropriate and equitable services.

New York

The New York Department of Health released an update to its value-based payment (VBP) roadmap. The update is open for public comment through April 18. The state is attempting to move 80 percent of Medicaid reimbursements to a VBP approach by the end of its five-year Delivery System Reform Incentive Payment waiver period.

Pennsylvania

Pennsylvania Governor Tom Wolf recently proposed funding in the state’s budget to address the opioid epidemic in Pennsylvania through health homes, which allow for coordinated care and treatment. Governor Wolf’s $34 million plan will create 50 new Health Homes over two phases.  

The Pennsylvania Health Access Network (PHAN)  is hosting a gathering in Philadelphia to talk about using Pennsylvania’s Medicaid dollars to help beneficiaries find stable housing.  This is the first in a PHAN’s  series of “Housing as Health” community forums across the state.

Rhode Island

William J. “Bill” Flynn, Executive Director of the Senior Agenda Coalition of Rhode Island, a Community Catalyst partner, was recently named an Honorable Mention Award winner in the National Association for Community Affiliated Plans’ (ACAP) Leadership in Advocacy Awards. Flynn was nominated by Neighborhood Health Plan of Rhode Island for his work to improve the health and well-being of the state’s elderly residents. Bill and his team at the Senior Agenda Coalition of Rhode Island focus on issues that help older Rhode Islanders maintain choice and dignity in their living and social environments and to promote programs that protect seniors' quality of life.

South Carolina

On April 1, dual eligible beneficiaries in 20 counties were passively enrolled into Healthy Connections Prime, the state’s demonstration project for dually eligible beneficiaries 65 and older. The second wave of passive enrollment will begin in July 2016, affecting beneficiaries in 19 additional counties.

Wisconsin

The Wisconsin Department of Health Services published a concept paper on proposed changes to the state’s Medicaid long-term services and supports (LTSS) programs. The proposed redesign would move more than 55,000 Medicaid beneficiaries using LTSS into integrated health agencies which would be responsible for coordinating all of an individual’s care needs, including long-term care, primary and acute care, and behavioral health care.

The Wisconsin Department of Health Services recently published a concept paper regarding proposed changes to the state’s Medicaid long-term services and supports programs.

Subscribe to

The Dual Agenda Newsletter

Support Our Work:

Donate