A group reforming how all medical care is paid for in the state butted heads Thursday with a group of healthcare advocates who are worried about steps the group is taking with the Medicaid population.
The group of advocates thought they reached a compromise with the State Innovation Model group back in December, but a second grant application to the federal government this month shows the state moving ahead with a “shared savings” model for the low-income Medicaid population.
The 25 advocacy organizations that signed this letter Thursday worry that under a “shared savings” model health providers would be tempted to deny Medicaid patients care or access to specialists because there would be a financial incentive to not provide that care.
New Haven Legal Assistance Attorney Sheldon Toubman told the group Thursday that it was their “moment of truth.” Would they listen to the advocates or ignore them?
Lt. Gov. Nancy Wyman took umbrage with Toubman’s characterization of the choices and what those choices mean for the state.
“With all due respect, Sheldon, I believe the advocates are having their opinion heard,” Wyman said. “In fact, many are sitting on this board right now.”
She said she doesn’t believe the group was “going back on its words” in revising the application to include the Medicaid population in the “shared savings” model.
“There has never been a feeling that the grant was more important than the people that we serve,” Wyman said.
However, Toubman said at times during this process it’s felt like obtaining the $100 million federal grant was more important than the changes being made to the Medicaid population.
Department of Social Services Commissioner Roderick Bremby said he knows the group worked really hard to reach what they thought was a consensus in December, “but sometimes things change.” He said the world changes with new knowledge and that knowledge must be used to give Connecticut the best possible outcome.
Mark Schaefer, director of Health Innovation, said he thought there was language in the application that said they would only move forward with the first wave of 200,000 Medicaid patients in January 2016 as long as the safeguards are in place to make sure patients are not denied care. What those safeguards are is still under discussion.
Advocates worry that the state will seek a waiver that would give it flexibility to implement a new payment method, but such a waiver comes with the risk of losing federal funds the state currently receives for the Medicaid population.
Generally, under this method the state would set a cap for how much it would spend on Medicaid and then come up with ways to stay under the spending cap. The advocates worry about what the state would have to do in order to stay under the cap because it may mean fewer services for Medicaid patients.
He said the idea of a waiver doesn’t necessarily mean there would need to be a global cap on how much is spent on the Medicaid population.
“A 1115 waiver can be an exceptionally broad tool whereby states can provide a global cap for expenditures for all of its Medicaid population and in exchange for that the federal government provides maximum flexibility,” Bremby said. “We do not intend to approach that style of implementation in any way shape or form.”
For example, in the Bridgeport area the state would focus on people with asthma and test whether certain expenditures — or treatments — not currently available under Medicaid could be used to enhance outcomes while reducing the cost of Medicaid expenditures. He said the use of the waiver would be targeted in specific locations on specific populations.
Frances Padilla, president of the Universal Health Care Foundation, warned that the state can’t “hang its hat” on receiving one of these waivers because things in Washington change and when they change so does the appetite for granting these types of waivers.