Friday’s Medicaid Council meeting focused on eligibility,
renewal changes and implementation with a very helpful
primer on the process. There is no clear answer to why
Medicaid membership has dropped by 34,232 since October, but the transition
to MAGI income rules and renewal delays to protect consumers from lapses in
coverage are probably part of the answer. DSS expects the decline to continue
for some time. But it may also be due to the slow but steady economic recovery.
However we learned that because of delays in renewals, to allow time for
complete processing and paperwork, some HUSKY members will be found to be over
income and ineligible. While providers will be paid for services provided in
the interim, consumers will be expected to repay the costs of their care during
the time they were not eligible but did not know it. At a future meeting, the
Council will further discuss the issue, and barring fraud, how to avoid punishing
people who acted in good faith based on the information they received from the
state.
We also received troubling news at the PCCM/PCMH meeting Friday
afternoon about the timeline to design the payment system transformation of the
entire Medicaid program. Unfortunately, this
is exactly what advocates have been concerned about with SIM. To meet the
SIM mini-grant timeline for shared savings in Medicaid, DSS must have an RFP
for the large ACO-like provider networks that will accept financial risk by May
1st. Advocates were very concerned that this timeline is not
responsible or realistic to ensure that Medicaid members are protected, or that
we don’t repeat the disaster of HUSKY managed care organizations, and unravel recent
progress in better quality, access to care, and cost stability. To engage
any real interest from applicants, the RFP must include very specific
qualifications, formulas for measuring savings and how they will be
distributed, as well as attribution, quality benchmarks and underservice
monitoring methodologies. Advocates are concerned that the design has already
been decided behind closed doors. (We did learn that consumers will have a
choice among providers. A decision that has already been made apparently, but a
good one.) We were also disturbed to read again that for the quality benchmarks
for granting savings payments to ACOs, DSS will “reach consensus with the (SIM)
PMO regarding the core measure set.” We were assured (again) that this does not
mean that inappropriate, weaker quality measures will be chosen for the unique
Medicaid population. However, we were assured earlier that the state would take
the necessary time to build the program responsibly. We also learned that
quality measures being discussed for use for PCMH bonuses were now also expected
to serve as the basis for the quality benchmarks for granting shared savings –
a very very different purpose with very different incentives and impact.
It is important to note that, just two days before this
meeting, the
Governor proposed cutting funding for the “shovel-ready”, very promising,
well-planned shared savings plan for the most fragile and costly Medicaid
members. This plan, with great potential to both improve care coordination and
access while holding down costs in the most expensive part of the program was
worked out over the last three years by a diverse, transparent stakeholder
group with varied expertise the state could not engage behind closed doors.
