« The Dual Agenda: August 11, 206 Issue

State Highlights

Alabama

Cuts to Alabama’s Medicaid program went into effect on Aug. 1 following the state’s inability to resolve an $85 million shortfall in funding for the program. Fees paid to providers who care for Medicaid patients were cut, on average, by 30 percent. Governor Robert Bentley is preparing to call the state Legislature into a special session beginning Aug. 15 and will propose a state lottery to address the state’s persistent budget shortfalls. Establishing a lottery in Alabama will require a change in the state constitution and would have to be approved by the voters. The outcome of the proposal in both the Legislature and before the state’s voters is uncertain.

A grassroots coalition, #IAmMedicaid, held a press conference on Aug. 3 in Huntsville, highlighting  repeatedly the ripple effect of Medicaid cuts to everyone in Alabama. More than 1 million people in Alabama receive health care insurance through Medicaid, the organization said. That total is made up 56 percent by children and 28 percent by elderly or disabled people. More than half the childbirths in Alabama are also covered by Medicaid. Beyond bypassing federal funding available to close the gap, these cuts are now moving Alabama further in the opposite direction of national efforts to transform the health system and expand access.

California

The California Department of Health Care Services issued an updated continuity of care provider bulletin explaining how current out-of-network physicians can continue seeing enrollees of Cal MediConnect, the state’s dual eligible demonstration project, as well as a reminder of the prohibition against balance billing. Additionally, the latest Cal MediConnect enrollment numbers are now available.

In other news, the California Long-Term Care Education Center worked in conjunction with researchers from the University of California, San Francisco (UCSF) on a pilot program to determine whether educating In-Home Supportive Services (IHSS) caregivers, who are paid to care for low-income seniors and people with disabilities, and integrating them into the medical team would improve the health of their patients. Under the pilot program, nearly 6,000 aides in Los Angeles, San Bernardino and Contra Costa counties were trained in CPR and first aid as well as in infection control, medications, chronic diseases and other areas. The training was conducted under a three-year, $11.8 million grant from the federal Centers for Medicare and Medicaid Services. The results of the study show that paid caregivers play a pivotal role in keeping people out of the hospital. As an example, the rate of repeated emergency room visits declined by 24 percent, on average, in the first year after caregivers were trained and 41 percent in the second year, according to the UCSF analysis.

Massachusetts

The Massachusetts Health Policy Commission announced $11.3 million in investments as part of its Health Care Innovation Investment Program (HCII). The HCII offers funding for competitive programs seeking to transform the health care system by improving care and reducing costs. Awards focused on three areas of innovation, including targeted cost challenge investments, which are focused on taking delivery and payment reforms to scale, telemedicine pilots, and mother and infant-focused neo-natal abstinence syndrome interventions.  

As reported earlier in The Dual Agenda Massachusetts is moving forward with its five-year 1115 waiver extension proposal that would move the state’s Medicaid recipients into one of three different Accountable Care Organization models as part of the state’s efforts to move to a value-based payment system. The federal public comment period on the state’s proposal is now open, with comments due to Medicaid via online submission by Sept. 3, 2016.

Michigan

The Michigan Department of Health and Human Services (MDHHS) posted the latest enrollment numbers for the MI Health Link dual eligible demonstration project. MDHHS also posted provider information regarding the deeming period that has now started for those individuals who have lost Medicaid eligibility. The deeming period will allow these individuals to remain enrolled in MI Health Link for up to three months while they work to resolve their eligibility issues.

New York 

New York Medicaid Director Jason Helgerson’s presentation at the annual United Hospital Fund Medicaid conference on July 14 is now publicly available. Helgerson spoke about the progress NY Medicaid has made thus far on delivery reform and cost control, and discussed future reform efforts for NY Medicaid. Specifically, he noted that the program will begin to focus on the social and economic determinants of health, beginning with a pilot program in Albany focused on kindergarten readiness.

In other news, the New York Department of Health (DOH) is accepting comments on its five-year transition plan to comply with new the CMS rule on Home and Community-Based Services. The CMS rule, which was published in January 2014, is designed to increase the level of person-centered care in Medicaid-funded long-term services and supports in both residential and community settings. The deadline for comments to DOH’s transition plan is Sept. 9, 2016.

Ohio

The Medicare-Medicaid Coordination Office (MMCO) posted a summary of amendments to the three-way contract for MyCare Ohio, the state’s dual eligible demonstration project.

The governor of Ohio announced the Ohio Comprehensive Primary Care Plus (CPC+) Program, under which Ohio's four largest health plans, along with Medicaid and Medicare, will begin paying more to primary care practices that recommend preventive services, coordinate physical and mental health care, offer extended hours and provide other supports shown to improve the health of their patients. Under the program, primary care providers will receive an extra four dollars monthly, on average, per Medicaid beneficiary, to help defray some of the costs of coordinating health care and extending their office hours.

Oregon

Oregon state Rep. Mitch Greenlick intends to introduce legislation that will require all Coordinated Care Organizations (CCOs) to become non-profit entities by 2023, thereby  requiring CCO governing boards to be open to the public and in compliance with the Open Meetings Law. Greenlick is adamant about reforming CCOs so they resemble a social insurance model with greater public accountability. To start the process, the Oregon Health Policy Board will hold a series of listening sessions throughout the state in September and will also conduct an online survey to gather consumers’ experiences with CCOs.

South Carolina

South Carolina’s Department of Health and Human Services (DHHS) posted the latest stakeholder update for the Healthy Connections Prime dual eligible demonstration project.

Among the updates: On July 1, health plan coverage began for over 7,500 members who were enrolled in Wave 2 of passive enrollment; With provider Advicare dropping out of the demonstration, Advicare Advocate members will have new health insurance effective September 1, 2016 and there will be no gap in coverage for Medicaid, Medicare or Medicare Part D prescription drugs.

Texas

The Medicare-Medicaid Coordination Office posted a summary of amendments to the three-way contract for the Texas Dual Eligible Integrated Care Demonstration Project.

Virginia

The Medicare-Medicaid Coordination Office posted a summary of amendments to the three-way contract for the Virginia Commonwealth Coordinated Care dual eligible demonstration project.

Washington

MedStar, Washington Hospital Center’s Medical House Call Program, is profiled in a new Commonwealth Fund series of case studies profiling innovative programs designed for patients with the most complex needs.  MedStar is participating in the Centers for Medicare and Medicaid Services’ Independence at Home Demonstration. This promising program relies on geriatricians, nurse practitioners and social workers to make house calls to frail elders who are unable to make it to the doctor’s office.

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