Medicaid Council update

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Friday’s Council meeting was mixed. DSS described their process for developing person-centered medical homes — a far better name. Their provider advisory group will be guiding the department in choosing which PCMH standards providers will have to meet, how they will be paid and the outcomes they will be measured against. Doctors are well-represented (a very good thing – 17 of 19 members are MDs), but other PMCH team members (care managers, nurses, practice managers, and other providers) are in the back of the room and not allowed to speak. There is another separate provider group just for pediatricians. DSS will have one-time focus groups with consumers to include general care experience of care questions but not vetting standards, payment methods or outcome measure options, and as focus groups they are not open meetings. DSS will also be coming back to the PCCM Committee – open public meetings at which anyone can speak, including providers in the other groups, HMOs, consultants, job seekers, advocates, etc. – and the Council for input. Other concerns about PCMH development include an over-emphasis on electronic medical records (there is a lot more to person-centered care and teamwork) and the need to integrate DSS’ plans for PCMHs with other payers. Most CT providers receive payment from many sources – expecting them to comply with different standards and reporting requirements just for Medicaid could be a disincentive to participation.

In other news, the Dental Health Partnership reported on continued progress in engaging providers and limiting over-treatments such as multiple X-rays. Advocates raised concerns about limited panels in Windom County. DSS described their plans to raise premiums on existing Charter Oak plan members, included in this year’s budget, and plans to shift new applicants with pre-existing conditions to the CT Pre-Existing Condition Insurance Plan. They also plan to shift that program from the current age-based rate system to a flat rate. Current rates vary between $243 and 893 per month per person; DSS is seeking permission to charge $381 per month for everyone. This will save most members on their premiums and allow the state to better draw down our federal allotment. Charter Oak currently costs $307 per member per month (unsubsidized) but that rate will increase Sept. 1st.

Selina Tirtajana and I presented the results of the CT Health Policy Project’s Fixing Medicaid report on provider participation in Medicaid and recommendations for improvement.
Ellen Andrews