Last week independent advocates
sent
a letter to DSS urging them to preserve and support person-centered medical
homes (PCMHs) in Medicaid redesign, but unfortunately our concerns were
dismissed by the administration. PMCHs are the only reform that has extensive
support in the literature as improving both access to quality care and success
in controlling costs. By all accounts, PCMHs are the foundation of CT
Medicaid’s nationally recognized success. We are deeply concerned that DSS’s
plans will give very generous incentives to move less lucrative members with
difficult problems out of PCMHs (the people who need it the most) and move more
lucrative members with resources into PCMHs. We are also concerned that the
policy will result in risk segmentation that will give a false finding that “shared
savings” is working and escalate Medicaid costs to the state without anything
actually changing. All participants in Medicaid redesign planning, including
leadership, have affirmed the principle of supporting PCMHs as a priority. The
advocates asked that all networks that wish to receive the extra bonuses be
certified as PCMHs within the time frame DSS chose or forfeit some part of
those savings. We also offered good faith waivers for practices that are making
a real effort. The four advocates on the letter are members of the Medicaid
Council committee that has been hashing out the program’s redesign with DSS
over many months. Based on encouraging conversations and a lot of work and
compromise to accommodate the department’s and networks’ objections over the
last many months, the advocates were very surprised by the department’s recent
decision to reject meaningful PCMH standards. In any event, there will no
change to existing providers taking Medicaid – the new consumer protections
would only apply to those who want to receive shared savings bonuses in
addition to multiple other current revenue streams.
