CMS announces new assistance for states to improve health system, many SIM alternatives

Today CMS unveiled the Innovation Accelerator Program providing states with over 50 tools, programs and technical assistance to improve Medicaid programs – both delivery and payment reforms. SIM is only one of the dozens of tools listed. The tools include numerous alternatives to CT’s risky SIM proposal to achieve every one of the goals outlined in the CT SIM final plan.

SIM moving ahead with risky Medicaid plan despite 25 advocates’ objections

At yesterday’s meeting, the SIM steering committee chose to move ahead with plans to radically change the Medicaid program – to include shared savings and an 1115 waiver. The new plan, rushed out in only a few weeks, reverses earlier assurances to advocates that the state would go slowly into shared savings payment incentives, recognizing that people in the program are at higher risk of underservice.  New features unveiled at yesterday’s meeting include that the eventual plan is to move 600,000 Medicaid members into shared savings over the next six years, only beginning with 200,000 or more Jan. 1, 2016. We also had our first look at the proposed SIM budget, which includes only a small sum for monitoring underservice, less than for focus groups and other consumer education or program evaluation. The budget was developed by collecting requests from the “owners” of SIM – state agencies. However state officials assert that the grant is not motivated by bringing federal funding to the state. Twenty five independent consumer advocates, who do not stand to benefit from the decision either way, signed a letter opposing the new Medicaid plan, concerned about serious harms to Medicaid clients who struggle now to access care, and jeopardizing recent hard-fought progress in the program. But committee members were not persuaded,  believing the potential benefits outweigh the risks.

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.

Questions for SIM about radical new Medicaid proposal

Questions sent yesterday for today’s meeting about SIM’s risky, new Medicaid proposal have been posted. One asks why a dangerous 1115 waiver is necessary? Did SIM planners explore other, less dangerous options? 1115 waivers necessarily include a cap on federal reimbursement (to meet the federal budget neutrality requirement) endangering the state budget and potential future Medicaid cuts if health costs continue to rise. The two stated reasons for a waiver – covering community health worker preventive services, and providing air conditioners for people with asthma – are not compelling. As of Jan. 1^st federal rules changed to allow Medicaid payment for CHW services and the extra state cost of air conditioners for 75% of Medicaid adults with asthma is minimal. Advocates have many concerns about the skeletal proposal rushed out to win a federal grant. The MAPOC will hear from SIM proponents about their plan this morning at 9:30 in Room 2C of the LOB.

Special Medicaid Council meeting on new SIM Medicaid plan

The very new SIM plan for Medicaid will be the subject of a special MAPOC meeting tomorrow July 8^th at 9:30 in Room 2C of the LOB. Concerns have been raised about both the content and the process for this radical departure from the original SIM plan for CT’s largest health plan. We expect more details on the plan soon, but what we’ve heard is here and here.

CT Health reform dashboard down – change in SIM/Medicaid plan largely responsible

CT’s Health Reform Progress Meter is down this month to 28.5%, mainly because of a new, rushed reversal on the original SIM plan to put Medicaid members’ care under financial risk, pursue a waiver that caps federal reimbursements putting the state budget and benefits in the state’s largest health plan at substantial risk, and a silly health savings account proposal for low-income Medicaid members. There are few details on the new plan being readied for the SIM grant application due in a few weeks. The new SIM proposal outweighed progress protecting national standards for patient-centered medical homes, also at risk in the original SIM proposal. SIM is being driven by an effort by the administration to secure a federal grant to fund state agencies. Positive progress in CT includes movement toward underservice protections and a final agreement in developing a constructive Medicaid/Medicare health neighborhoods plan. The progress meter is part of the CT Health Reform Dashboard.

CT News Junkie Op-Ed: SIM shouldn’t just chase a federal grant

A new Op-Ed in CT News Junkie outlines consumer advocate concerns that SIM planners are putting their pursuit of a federal grant ahead of what’s best for CT. Contrary to the original plan, SIM leaders are now planning to move Medicaid back to an incentive scheme similar to the failed HUSKY HMOs. Since we moved away from that system two years ago, health outcomes are up, more providers are participating in Medicaid, and the cost of care per person is down. That hard won progress would be at risk in SIM’s new proposal. The plan also includes pursuing a Medicaid waiver that would cap federal reimbursements to the state, putting taxpayers at significant financial risk if health costs in our state increase or the economy doesn’t rebound. The sole motivation for this reversal is to get a $50 million federal SIM grant to benefit state agencies. Consumers don’t care if state agencies get more funding – we only care about making our health care system work better.