Medicaid Managed Care/PCCM update

Today’s Medicaid Managed Care Council included an update on PCCM given the expansion to New Haven and Hartford January 1st. It was noted that there has been great interest among providers with 122 signed up in New Haven and 47 in Hartford so far and more applications expected. Unfortunately, DSS has refused to remove the unnecessary and intimidating Freedom of Information requirements on providers in PCCM (but not on those enrolled in the HMO panels) or to devote any resources to marketing PCCM. This is in contrast to considerable approved expenditures of taxpayer dollars by HMOs for marketing. But DSS confirmed press reports that they will now be prohibiting the HMOs from spending HUSKY dollars on marketing going forward. They were not specific about how that would be enforced or what the penalties will be. We also reported concerns about the PCCM evaluation planned for this summer, which is premature given the very low enrollment, and using Mercer as the evaluator given their significant business with managed care plans and whether this constitutes a conflict of interest. However, it was noted that many providers are excited about the medical home model encouraged by other payers and are interested in participating in PCCM to support practice transformation.
Enrollment data found, not surprisingly, that the numbers of HUSKY B and Charter Oak members who are not renewing in the programs and Charter Oak members not paying their premiums are up sharply. ACS is surveying those members to find out why. DSS talked about their plans to increase Charter Oak premiums significantly starting February 1st. The rates will increase 72% for people at the lowest income levels compared to 15% for the highest income members because DSS has chosen to rate by income bands. There was a great deal of discussion about opportunities for millions in federal funding that DSS is missing by not applying due to staff shortages. However, it was noted that DPH is partnering with nonprofits and others to ensure that they take advantage of every opportunity and that providers have been doing more with fewer resources for many years.
DSS described their response to the court decision prohibiting coverage denials to legal immigrants. During the meeting, it was announced that the judge denied DSS’ request for a stay of the order. DSS has only been reversing disenrollments on a case-by-case basis and not accepting new applications, possibly in violation of the court order. A Danbury Hospital representative noted that they have a patient currently in chemotherapy who was disenrolled, had to shift to Charter Oak and is struggling with the costs and will very likely hit the annual limit. They were not informed that they could appeal to DSS for a review to restore the patient’s Medicaid coverage.
Ellen Andrews