HUSKY waiver hearing – good and bad news on PCCM

As expected, yesterday’s Medicaid waiver hearing before the Human Services and Appropriations Committees was contentious and long. DSS brought out the troops – I counted nineteen staff in the room and they flew in two actuaries from Mercer. CMS also came in from Boston. DSS began with a rosy, but incomplete, description of the program and of PCCM. We did learn that the program is up to 200 members now. They left out the part about the working group of advocates, providers and DSS staff which developed a state plan last summer, submitted to and approved by the legislative committees in September without revision. That plan called for statewide, expansive implementation open to any willing provider and any HUSKY families within 20 miles of a PCCM provider. They left out the part about DSS, in November, suddenly deciding to limit the program to two small communities, only providers who applied during a very short time frame, and only to some of their current patients. DSS stated, in error, that those two communities were the only ones with sufficient provider capacity to support PCCM. Advocates pointed out that the Commissioner admitted in a November letter to legislators that New Haven and Hartford also had sufficient capacity. They also left out that they are arbitrarily subjecting PCCM providers to Freedom of Information laws and refused to approve marketing and educational materials developed by the working group for consumers to explain the program. Sensing the likelihood of criticism from legislators, consumer advocates and others who care about health care for HUSKY families, DSS offered a symbolic amendment saying they would expand PCCM statewide sometime in the next two years and it was their “intention” to be statewide by the end of 2009.

In their testimony, advocates and providers universally expressed strong support for PCCM and state wide implementation. Click here for our testimony. Speakers also argued for opening the program to any providers willing to care for HUSKY families, eliminating irrelevant and intimidating Freedom of Information burdens on doctors’ offices, PCCM marketing efforts equivalent to the HUSKY HMOs (funded by taxpayers), and opening the program to all HUSKY families. The advocates described recruiting 350+ providers this summer from across the state to apply to the program, providers who are sick of the HMOs, the hassles, and the lousy rates, and getting ready to leave the program but who were willing to stay and give PCCM a chance. Unfortunately, DSS said no thanks to all but 25 of them who practice in Waterbury and Willimantic. The advocates emphasized that since November, DSS has systematically hobbled the program to the point where it is no longer viable for providers, ensuring it will fail. HUSKY needs PCCM as an alternative to the troubled HMOs. Advocates noted that if the committees allowed DSS to destroy PCCM, they need to get used to 24% HMO rate increases.

Legislators expressed deep frustration with the department for the delays and policy changes to weaken the program. They drafted a different amendment (and then amended that), negotiating the terms in a back room with only DSS and OPM staff. Advocates were told to leave the room. The amendment requires DSS to market the program and open it to any willing providers and families in the pilot areas. That’s the good part. However, the amendment also requires DSS to implement PCCM in Hartford and New Haven only by the end of 2009 and to commission an evaluation (DSS directed) six months later to assess quality, access to care, and cost containment. If that evaluation finds that PCCM is “successful” they may expand it farther. That’s the bad part. Staywell Health Center, Waterbury’s community health center, testified that they have only twenty PCCM patients enrolled because of DSS’ limitations. Staywell will get the massive sum of $1,800 per year to manage the care of those patients. What are the chances that DSS’ evaluator will find improved access, higher quality AND reduced costs with those resources?
Ellen Andrews