Medicaid Council voices concerns about new SIM proposal

In a special meeting yesterday, the majority of Medicaid Council members voiced concerns about the rushed, new SIM proposal for Medicaid. Legislators compared the new proposal to the failed HUSKY HMO proposal 20 years ago and made it clear that they are concerned about “going back down that road”. Concerns included the application’s aggressive pace of reform with several speakers asking DSS to slow down and revert to the original SIM plan that staged reforms with time for evaluation and improvements in between, building on lessons learned. Speakers were concerned that the move to shared savings would undermine the successful PCMH program that is improving care, engaging more providers and controlling costs. In fact, CT Medicaid spending is under control, projected to drop even, over the next several years. Strong concerns were raised about the dangers of an 1115 waiver, even if intended for a purpose everyone could support, could later be used to deny care to people as has happened in the past when the state budget runs into deficit. Advocates pointed out that there are other, less risky ways to accomplish the goals outlined for the 1115 waiver. Speakers were concerned about the priority focus on cost savings over improving quality. Concerns were raised that shared savings is relatively new across the US, and that it has not been universally successful. There were strong concerns about exacerbating underservice, which happens frequently now in the program under fee-for-service, without new incentives to deny care. SIM proponents acknowledged that the new proposal was precipitated by securing a federal grant but believe that the potential benefits outweigh the risks. Representatives from ProHealth and CT’s community health centers, both of which would potentially benefit from the proposal, spoke in favor of the proposal.