Medicaid Managed Care Council update

We ran out of time at Friday’s Council meeting, so we will devote the entire June meeting to discussing how the state plans to implement the new budget provision to self-insure the HUSKY/SAGA/Charter Oak program. Some of the decision points are whether to keep the program capitated but without financial risk (not sure how that works), whether we can continue to allow some providers to be paid more than others, whether to re-bid the contracts for one or more ASOs (or just keep the current HUSKY HMOs as happened last time), and whether we can have (or need) more than one ASO. Other HMOs are interested in applying now that the program does not carry financial risk. Apparently, responses from the current HUSKY HMOs to the RFP to provide non-risk care management services to the current Medicaid fee-for-service population were not cost effective.

In other reports, the Council heard about important work being done by the Women’s Health Subcommittee and Community Health Center, Inc to prevent low birth weight babies and improve breastfeeding rates by getting pregnant women into prenatal care early, ensuring access to dental care, smoking cessation and identifying and treating depression during pregnancy. The committee is planning a prenatal care summit in the fall.

Mercer gave their usual, glowing evaluation of the HMOs. Under questioning, it became clear that their evaluation is only of processes, and does not reflect actual access to care for members. Performance studies were not promising; at best, there was little progress on any health outcome or process measures. The CT Dental Health Partnership continues its impressive progress to enroll more providers and expand access to oral health care. And PCCM enrollment is up to 388 as of May 1st; up from 359 a month before.

And the Council’s name changed to the Council on Medicaid Care Management Oversight.
Ellen Andrews