Medicaid update – lots of success but a concerning turf battle

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Friday’s Medicaid Council meeting focused on new initiatives to rebalance care for long term supports and services. Through a impressive quilt of waivers, DSS has improved incentives for providers, expanded available services, reduced and eliminated waiting lists, and reduced costs allowing fragile people to remain in their homes avoiding costly and unwanted nursing home stays.
Last week’s meeting of the council’s care management committee highlighted continued success engaging and supporting CT practices in transforming to patient-centered medical homes. 282,232 CT Medicaid members can now access coordinated care that meets national accreditation standards at 327 individual sites across the state, up 300% since the beginning of 2012. And 51 more sites are on the glide path to PCMH recognition. DSS and CHN deserve a great deal of credit for their success in delivering quality care, sustained over years, turning around a program that has languished for decades.

Unfortunately a conflict between SIM and MAPOC has arisen over control of Medicaid policymaking; independent advocates are concerned that the program’s successes are at risk. In alignment with a letter from the Lieutenant Governor and DSS Commissioner, legislative leaders have assigned MAPOC’s Care Management Committee the task of advising the state on “all aspects of the shared savings program design and the selection of provider participants.” This mirrors the very successful model of collaboration between MAPOC’s Complex Care Committee and DSS in developing a strong model of shared savings for dual eligible members especially a consensus set of standardsprotecting fragile members from inappropriate underservice. Unfortunately SIM staff is insisting that a SIM committee, dominated by private insurers, retain control over development of the crucial under-service measures for the entire Medicaid program. Advocates are concerned that the committee does not include sufficient Medicaid expertise and questions the dominant role of private insurers who no longer operate our state’s Medicaid program, in large part because of inappropriate underservice. Since private insurers left Medicaid, quality of care is up, more providers are participating, and per person costs are down.