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At today’s Medicaid Managed Care Council, the HUSKY HMOs’ provider panel reports showed that progress continues to be very slow. Sen. Harris pointed out that at this pace, the two new HMOs will take over a year to reach capacity similar to CHN’s panels. In the counties already transitioning to the HMOs, 94% of HUSKY members have not been able to choose an HMO. DSS still plans to default everyone in the state into an HMO as of December 1st. Letters to that effect will be going out to families in two weeks giving them 30 days to choose a plan or be assigned to one.
Plans for PCCM continue with an anticipated start date of Jan. 1st. Legislators strongly urged DSS to wait to default members into plans until PCCM is operational giving consumers the best array of options and giving PCCM a fair chance to succeed. DSS announced three PCCM provider forums.
DSS also released numbers suggesting that the state saved money under the old HMO-based system compared to the interim fee-for-service based system we have now. They stated that total HUSKY costs in Oct. 2007 (before the HMOs left the program) were $61.4 million and in April 2008 (during the fee-for-service period) costs were $73.3 million. However those numbers do not account for the increase in enrollment of 11,483 people between those dates or the (very high) $18.18 per member per month fee paid to the HMOs in April for administrative processing. However, even if we allow DSS those numbers, adding the 24% increase in rates to the former HMO spending (Oct. 2007 numbers) brings the monthly spending $3 million higher per month than fee-for-service (April 2008 number). The bottom line is that, even using DSS’ numbers, we will likely be spending significantly more under the new HMOs than we did under fee-for-service.
Thankfully, there is good news on the dental carve out. The number of participating dental providers has almost doubled; there are now 342 “Doors Open for Access” or sites to access dental care for HUSKY families across CT with 674 participating providers. We lost a very small number due to lower payments but picked up far more in the new system independent of HMOs. This is very encouraging news for PCCM which is also independent of HMOs.
Ellen Andrews