At yesterday’s meeting, the SIM steering committee chose to move ahead with plans to radically change the Medicaid program – to include shared savings and an 1115 waiver. The new plan, rushed out in only a few weeks, reverses earlier assurances to advocates that the state would go slowly into shared savings payment incentives, recognizing that people in the program are at higher risk of underservice. New features unveiled at yesterday’s meeting include that the eventual plan is to move 600,000 Medicaid members into shared savings over the next six years, only beginning with 200,000 or more Jan. 1, 2016. We also had our first look at the proposed SIM budget, which includes only a small sum for monitoring underservice, less than for focus groups and other consumer education or program evaluation. The budget was developed by collecting requests from the “owners” of SIM – state agencies. However state officials assert that the grant is not motivated by bringing federal funding to the state. Twenty five independent consumer advocates, who do not stand to benefit from the decision either way, signed a letter opposing the new Medicaid plan, concerned about serious harms to Medicaid clients who struggle now to access care, and jeopardizing recent hard-fought progress in the program. But committee members were not persuaded, believing the potential benefits outweigh the risks.