Twenty-three independent advocates sent
a letter today again urging the state to conduct a common-sense evaluation
of the first wave of a risky new program before expanding the program, as
promised. Advocates have
learned that the planned evaluation will not be available until two months
after the RFP for the second wave is finalized and released. In addition, current
plans for the evaluation
are weak, very similar to cursory evaluations of HUSKY MCOs that found no
problems over many years despite obvious lapses and overspending. We also
understand that data will not be available for a robust review in time to
inform the second wave even if there were a meaningful evaluation. January 1st
Medicaid enrolled over 100,000 members into a shared savings program, PCMH+, a
new financial model that has struggled to save money and improve quality where
it’s been tried. Advocates are concerned because this is a return to financial
risk models that have failed spectacularly in the past. Since Medicaid moved
away from financial risk five years ago, access to care and quality are up
substantially and the state has saved
almost $500 million. Another 200,000 members are tentatively scheduled to
be defaulted into PCMH+ next January 1st before anyone knows if the
historical problems have returned. The letter also outlines several other PCMH+
assurances of consumer protections that have not been honored.
