Connecticut’s Medicaid redesign update– Pros and Cons

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Connecticut’s Medicaid program has earned national recognition for combining improved access to high quality care with an impressive record of cost control. Shifting the program from a financial risk payment model to care coordination through person-centered medical homes (PCMHs) four years ago is widely credited with that success. Last year the administration began developing a new, ambitious reform plan, Medicaid Quality Improvement and Shared Savings Program (MQISSP) committed to build on and support the success of the PCMH program. The goals of MQISSP are to “improve health and satisfaction outcomes for Medicaid beneficiaries”.
Under MQISSP, the state intends to contract with competitively selected networks of providers, both Federally Qualified Health Centers and advanced networks (i.e. Accountable Care Organizations). Networks will coordinate person-centered care among a continuum of providers and community resources. Networks will share in the resulting savings in the total cost of care for their attributed members if they meet quality standards. Over the last year, the Department of Social Services (DSS) has worked with the Care Management Committee of Connecticut’s legislative Medical Assistance Program Oversight Council to develop the program. The Care Management Committee includes legislators, providers, consultants, and consumer advocates. As of April 2016, that process is largely complete and drafting has begun on the MQISSP application for networks.
Among fourteen major issues decided to date, most are very positive (pros) and will support the goals of improved quality and satisfaction. But three are problematic For more information, read the CT Health Policy Project brief.