« The Dual Agenda: March 9, 2016 Issue

State Highlights

Alabama

Reprising what was a difficult budget debate in 2015, the Alabama state Senate passed a preliminary budget proposal that defunds the state’s Medicaid reform efforts. While this opening salvo in the state’s budget debate is eerily similar to the path followed by policymakers last year, there remains time and opportunity to find an alternative way forward for Alabama in what is thus far a somewhat less fractious environment than in 2015.

California

The Department of Health Care Services will hold its next Coordinated Care Initiative (CCI) Stakeholder Update Call on March 17. The state has also released the Cal MediConnect Hospital Case Manager Toolkit. This resource is intended to be used in CCI counties participating in Cal MediConnect – California’s dual eligible demonstration project – to support enrollees before, during and after hospitalization. The toolkit can support hospital case managers as they work with beneficiaries through the admissions and discharge processes and also includes details on how to access and build upon care coordination services provided by Cal MediConnect health plans.

In other news, Governor Jerry Brown signed major health plan tax legislation on March 1 that includes an expanded tax on managed care organizations (MCOs). The tax is expected to bring the state more than one billion dollars in matching federal funds. The proposal now goes to the Centers for Medicare and Medicaid Services for review. In addition to the MCO tax bill, Governor Brown signed additional measures that will direct monies from the general fund to services for people with developmental disabilities and forgives millions from a budget debt owed by skilled-nursing facilities.

Massachusetts

Governor Charlie Baker’s administration is pursuing significant new reforms to the state’s Medicaid program, seeking to provide services to Medicaid recipients through Accountable Care Organizations. The administration is also seeking more oversight of the state’s long-term services and supports program, including instituting independent, conflict-free assessments of people’s overall needs before services are approved.

New York

The New York State Department of Health (NYSDOH) has released its Partnership Plan Medicaid 1115 Demonstration 2015 Annual Report. This year’s report includes data on Managed Long-Term Care enrollment, Conflict-Free Evaluation and Enrollment Center evaluations, Fair Hearings and appeals/grievances.

NYSDOH has also issued a "Request for Information" to solicit suggestions about the Programs of All-inclusive Care for the Elderly (PACE) model of services and supports. The state is seeking to enhance and expand its PACE program, specifically around the provision of long-term services and supports.

Ohio

The Ohio Consumer Voice for Integrated Care (OCVIC) coalition recently influenced a procedural change aimed at improving the coordination of care in MyCare Ohio, the state’s dual eligible demonstration project. With this change, the state has increased oversight of the requirement that MyCare Ohio enrollees review and sign their All Service Plans, a document case managers develop that specifies all the services necessary for an enrollee to remain in his or her home. The signature requirement is important because it ensures the enrollee has reviewed, understood and agreed to the contents of the plan and had an opportunity to provide input on their care.

Oregon

The Center for Outcomes Research and Education  recently released a study that directly assesses the impact on health care costs when low-income individuals move into affordable housing. Researchers analyzed Medicaid claims data for more than 1,600 residents living in 145 affordable housing projects in Portland, Oregon and found these residents used more primary care by 20 percent, had fewer emergency department visits by 18 percent, and accumulated lower medical expenditures by 12 percent. Residents also reported better access to and quality of health care.

Pennsylvania

On March 1, the state released a Request for Proposal and Agreement for Community HealthChoices, Pennsylvania’s managed long-term services and supports program. Managed care organizations have 60 days to respond. The program will first be rolled out in southwest Pennsylvania in 2016, with enrollment and services effective Jan. 1, 2017. It will be launched in the southeast region in January 2018 and in the northwest, Lehigh-Capital and northeast regions in January 2019.

Rhode Island

Rhode Island Governor Gina Raimondo has announced that the state has exceeded its cost savings goals one year into its Medicaid reform efforts. With a savings goal of $70 million, Gov. Raimondo asserts that the state is on track to save $77 million this year. Advocates, who have been involved in the working group identifying ways to reform the state’s Medicaid program, rightly caution that cost savings is not the only important measure of success. Improvements in care and in health outcomes should weigh equally heavily in evaluating the state’s efforts.

South Carolina

CMS posted a document outlining the continuity of care provisions for South Carolina Healthy Connections Prime, the state’s demonstration project for dual eligible beneficiaries 65 and older.

Virginia

Community Catalyst submitted comments to the Centers for Medicare and Medicaid Services (CMS) on Virginia’s 1115 waiver request. If approved, the waiver would allow the state to transform its Medicaid program and shift the state’s blind, elderly and disabled populations – including those with both Medicare and Medicaid – into capitated health plans. If approved, this move would result in the end of Commonwealth Coordinated Care , the state’s dual eligible demonstration project, next year. The waiver also seeks approval to implement a Delivery System Reform Incentive Payment (DSRIP) program. This would allow the state to use federal Medicaid funding to create financial incentives for providers to pursue a variety of delivery system reforms. 

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