CSG ERC is on Facebook

CT’s regional, multi-branch state policymaker support organization, CSG/ERC, is now on Facebook. The Council of State Government’s Eastern Region provides state policymakers with the latest information on critical policy topics, skill building, leadership training, and opportunities to exchange ideas and best practices with colleagues from around the region. CSG/ERC’s Health Policy Committee is chaired by CT’s Sen. Terry Gerratana. CSG/ERC’s Facebook page will facilitate resource sharing for busy policymakers across the region.

Advocates call on SIM to adopt state Code of Ethics

A letter was sent yesterday from independent consumer advocates to SIM leadership calling for SIM to follow CT’s Public Officials and State Employees Guide to the Code of Ethics, to protect the integrity of both SIM contracting and larger health reform efforts in our state. The advocates are asking for these protections now, before major procurements and the details of health reform are set in place, avoiding ethical concerns in the future and allowing reform to move forward confident that conflicted interests will not drive policy. The Affordable Care Act and SIM grant offer historic opportunities to reform our health system but also come with great responsibilities. Effective reform requires confidence and trust across all stakeholders. A strong ethics policy, that avoids even the perception of impropriety, is critical to success. Since 1977, the Code has covered all state contracting and procurements for public funds ensuring governmental integrity. The letter outlines previous examples of divergence from the Code that reduced credibility and harmed the public’s trust in CT state health policymaking. The letter also offers successful models to engage all voices, including those who will participate in SIM’s reforms, while maintaining independent decision making.

H&R Block report finds half of ACA subsidy recipients will have to pay IRS back; uninsured penalties average $172

A new analysis by H&R Block finds that 52% of taxpayers nationally who received subsidies last year to purchase coverage in the exchanges will owe the IRS an average of $530 for overpayments. The “settlement” is to reconcile insurance subsides paid based on estimated earnings during the year with actual earnings. On the positive side, about a third of filers over-estimated their incomes and will receive refunds averaging $365. The authors also found that the average penalty for being uninsured was $172, higher than the flat $95 per uninsured adult fee. Those penalties are scheduled to increase for next year’s taxes. Many of the filers did not understand their potential liability, that they were receiving a government subsidy, and virtually everyone was confused. Just because it wasn’t complicated enough, only half of households were covered under the same plan, requiring “multiple tax return impacts.” A companion report gives a nice explanation of the tax implications for consumers, with helpful examples.

More on budget cuts – it makes no sense

Providers and advocates detailed the potential impact if the Governor’s budget proposals are adopted in a CT Mirror article published today. Heading the list of counterproductive cuts is the proposal to derail Medicaid efforts to coordinate care for the most costly and fragile members, expanding the successful model that reversed the HUSKY mess under managed care organizations. That program has saved $420 million for the state over the last two years, while also improving the quality of care and attracting 32% more providers to the program. The pilot program the Governor wants to end is ready to go and is the product of three years of collaboration across diverse stakeholders – a model of how health reform can be successful in CT. The pilot relies on a shared savings payment model to reward providers for better value care. But in an odd twist, the administration’s SIM project is simultaneously planning to move at least 200,000 (less costly) Medicaid members into a hastily arranged shared savings model by Jan. 1^st with no prior planning. It doesn’t make sense.

Troubling Medicaid, SIM updates

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 1^st. 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.

New issue brief examines impact of Governor’s proposed Medicaid cuts

A new CTHPP issue brief explores the Governor’s budget proposals for the Medicaid program, CT’s largest coverage plan. The brief describes the costs of replacement coverage from the insurance exchange for the 34,000 HUSKY parents who would be cut in the Governor’s proposal. The brief also puts perspective on the cuts compared to savings in the program over the last two years from care management and quality reforms, declines in HUSKY A enrollment, and describes what could be lost if funding for final implementation of the innovative health neighborhood program is cut.

Governor proposes deep cuts to Medicaid

Updated February 19

Despite strong evidence of cost control and improving quality in the Medicaid program, today the Governor has proposed significant cuts to both eligibility and provider payment rates. The Governor has proposed cutting 34,000 low income parents off the HUSKY program. Parents in families of three with annual incomes as low as $28,000 will now have to buy insurance on the exchange. For comparison, a 28 year old Hartford parent of two children with an income of $32,000 choosing a Silver plan on the exchange (the most common plan) would pay between $1,460 per year for the parent’s coverage, 4.56% of their family income. Employer-sponsored coverage in CT has eroded significantly in the last decade, limiting that option for parents. The Governor has also proposed deep cuts in provider payment rates which will jeopardize broad engagement efforts that have increased the number of participating providers by 32%. 

This is particularly disappointing because of the significant progress in Medicaid both improving quality and controlling costs. Per person costs have been stable over the last two years, saving the state $420 million compared to most health coverage increases, more than the expected savings from the Governor’s proposed cuts. While the Medicaid program has a deficit this year of $120 million, the problems are mainly temporary, administrative issues that will be corrected.

In a classic case of penny-wise and pound-foolish, the Governor has also proposed eliminating funding for the health neighborhood program for people eligible for both Medicaid and Medicare. This program, a model of collaboration and how constructive health reform can happen in CT, has the potential to improve care and control costs for CT’s most fragile, and costly residents. After a great deal of hard work by all stakeholders, the program is very near implementation.

Other cuts proposed by the Governor include pharmacy fees, chiropractic care, closing the CT Home Care program to new applications and increasing costs for current clients, reducing the personal needs allowance for people living in long term care facilities, reducing burial funding for SAGA recipients, closing DSS’s Torrington office, increasing newborn screening fees, and cuts to grant programs.