Advocates’ concerns to preserve PCMHs in Medicaid reform rejected

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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.