« The Dual Agenda: May 18, 2016 Issue

State Highlights

Alabama

The Alabama state Legislature has voted to delay implementation of the state’s Medicaid reform program, which it overwhelmingly approved in 2013. However, legislators did vote to create a Joint Medicaid Study Group that has been conducting hearings to understand more clearly the challenges facing the Medicaid program, its critical role in the state’s health care system and the vulnerable consumers who get care through the program. Advocates remain hopeful that the governor will call the Legislature back into a special session later this year and that a solution to the budget stalemate that threatens Medicaid funding in the state, not to mention the Medicaid reform program, will be found.

California

California’s Department of Health Care Services (DHCS) recently shared some important announcements related to the Coordinated Care Initiative (CCI), which includes the state’s dual eligible demonstration project.

As a result of stakeholder input, DHCS will not move forward with annual passive enrollment, but instead will utilize a voluntary “opt-in” enrollment process.

The state has proposed several activities focused on strengthening Long-Term Services and Supports (LTSS) referrals and improving care coordination,  including standardizing the Health Risk Assessment (HRA) referral questions to reflect the best practices developed over the early years of the program and expanding data collection and reporting.

Beginning in summer 2016, the state will convene a series of meetings  with Cal MediConnect plans to share best practices and ensure all plans are performing to the highest standard.

The continuity-of-care period will be extended for Medicare services from six months to 12 months to match the Medi-Cal (Medicaid) continuity-of-care period and  requirements will be modified to just one visit with a specialist within the past 12 months, as is the case with primary care physicians.

The state is also exploring ways to make it easier for beneficiaries to stay enrolled in Cal MediConnect for more than 30 days while the health plan helps the beneficiary reestablish their Medi-Cal eligibility.

The Scan Foundation has published the results of a telephone survey of Cal Mediconnect beneficiaries. The survey is part of The Community Living Policy Center at the University of California, San Francisco and the UC Berkeley Health Research for Action Center three-year evaluation of the Cal MediConnect program. The purpose of the evaluation is to document the impact of the program on individuals' experiences with care, including access, quality and coordination. 

Also, starting in 2017, Covered California, the state’s ACA health insurance exchange, will require health plans to: demonstrate year-over-year reductions in health disparities in targeted areas of chronic disease; share quality and performance data for all lines of business; and demonstrate an increased percentage of self-reported demographic data for enrollees. 

Maryland

The Maryland Faith Community Health Network pilot program continues to gain steam, in signing up more than 50 participating congregations and enrolling individual congregants in the network. Inspired by a model from Memphis, Tennessee and organized by the Maryland Citizens Health Initiative, the network is being piloted in collaboration with LifeBridge Health, a health system with a rural, suburban and urban hospital.

Massachusetts

The Blue Cross Blue Shield Foundation of Massachusetts has issued a report prepared by Manatt Health that lays out a new vision for Long-Term Services and Supports (LTSS) in the commonwealth. The report identifies a series of policy options to improve the LTSS system so it is sustainable and improves quality of life for people using LTSS services.

In related news, MassHealth, the state’s Medicaid program, shared the latest enrollment numbers for the One Care program.

Finally, Massachusetts hospital executives are negotiating with the Service Employees International Union (SEIU), Local 1199, one of the state’s largest labor unions, over the fate of a proposed November 2016 ballot question that would significantly alter how hospitals are financed in Massachusetts. The ballot question, which is being spearheaded by the union and which will appear before voters this November if a negotiated agreement cannot be reached, would take money away from hospitals that are paid higher rates and redistribute those dollars to lower paid hospitals and to consumers. The Boston Globe has objected in an editorial to this process of “secret negotiations” to resolve widespread concerns in the state over hospital price disparities. John E. McDonough, a professor at the Harvard T. H. Chan School of Public Health, said the SEIU’s ballot question has forced the industry to contend with price disparities. “The conversation would not be going on at the level of intensity it is if it were not for the ballot initiative,” he said. “The implications are significant for the hospital community, which is why so many folks are paying so much attention to this.

Michigan

The April enrollment numbers for the MI Health Link program, the state's dual eligible demonstration project, have been posted on the state’s website.

Minnesota

The Centers for Medicare and Medicaid Services approved Minnesota’s Health Home State Plan Amendment (SPA), enabling the state to create behavioral health homes to provide integrated services to adults with serious and persistent mental illness and children and youth experiencing serious emotional disturbance. The SPA will be effective on July 1, 2016.

Behavioral health home certification by the state will be available to any eligible provider, statewide.  Recipients must have a current diagnostic assessment as performed or reviewed by a mental health professional employed or under contract with the behavioral health home. Individuals who meet the criteria will receive information regarding their choice to participate. All enrollment in behavioral health homes will be on an opt-in basis.

New Jersey

The Good Care Collaborative, led by the Camden Coalition of Healthcare Providers, convened state leaders in mental health care and substance use disorder treatment in Trenton, New Jersey last week to discuss Medicaid’s role in efforts to treat the whole patient and regulatory barriers to integrating behavioral health care into primary care offices. 

A Rutgers University study on Medicaid patients found that the top one percent of high-cost hospital users often had a mental health or substance abuse diagnosis. Additionally, studies have shown people with a behavioral health problem can live up to 25 years less than the rest of the population. Speakers at the conference were invited to discuss Medicaid's role in the reform efforts, as well as the regulatory barriers to integrating behavioral health care into primary care offices. Representatives from New York, Colorado and Tennessee were invited to share how Medicaid has improved mental health care delivery in those states.

New York

Children’s Defense Fund–New York and other Health Care for All New York (HCFANY) members are monitoring health system transformation in New York state to ensure that reforms reflect the unique health care needs of children. HCFANY’s new blog and factsheet  highlight guiding principles, opportunities and challenges for making sure health transformation works for kids.

In other news, HCFANY also published a blog  highlighting findings from a recent report  by Pioneer Institute that demonstrate the lack of basic price information available to health care consumers.

Medicaid Matters New York is conducting a survey to assess the degree to which community-based organizations (CBOs) are engaged in New York’s Delivery System Reform Incentive Program (DSRIP). The survey will illuminate where the need exists for advancing community interests in local DSRIP regions and spur state level advocacy to ensure the DSRIP process engages CBOs in meaningful ways.

Oregon

Oregon’s new waiver proposal for the Medicaid and Children’s Health Insurance Program includes a significant emphasis on supportive housing services for beneficiaries and also seeks additional funding to boost behavioral health coordination. The plan aims to drill down on key social determinants of health that have reached crisis levels in Oregon.

Pennsylvania

According to a Pittsburgh Post-Gazette article, fourteen managed care companies have submitted bids to participate in Community HealthChoices, the state’s managed long-term services and supports program. The program, which is expected to serve over 400,000 beneficiaries, is slated to start in southwest Pennsylvania on Jan. 1, 2017. The state is expected to choose the successful bidders in June.

South Carolina

Healthy Connections Prime, the state’s demonstration project for dually eligible beneficiaries 65 and older recently announced that a second wave of passive enrollment affecting beneficiaries in nineteen counties will begin in July 2016. Unlike the first wave of passive enrollment, beneficiaries in the second wave will include those who need home and community-based services. To date, almost 6,000 members have enrolled in a Coordinated and Integrated Care Organization (CICO) within the demonstration project.

Virginia

Last month, Virginia’s Department of Medical Assistance Services (DMAS) released its request for proposals (RFP) for the state’s Medicaid Managed Long-Term Services and Supports (MLTSS) program. The MLTSS will build upon the Commonwealth Coordinated Care (CCC) dual eligible demonstration program, which will be phased out at the end of 2017.

Subscribe to

The Dual Agenda Newsletter

Support Our Work:

Donate