Courtesy of CT-N

Lt. Gov. Nancy Wyman told the Health Care Cabinet Tuesday that the state made a promise and won’t consider moving to downside risk in its Medicaid program for at least another three years.

“We are not going to downside risk on our Medicaid program,” said Wyman, who was visibly annoyed and frustrated the topic continued to be raised by a group of independent healthcare advocates.


Downside risk is a payment method that requires doctors to assume the financial risk and lose money if they don’t save enough money on their patients. Advocates worry it would cause doctors to reduce care to certain patients who require a lot of care and would be viewed as hurting their bottom line. There’s also a fear that fewer doctors would participate in the Medicaid program where already they are being reimbursed less than what they are paid by private insurance carriers.

Wyman said the goal of the cabinet and the reason it hired a consultant was to hear about what the state can do about cost containment.

One of the proposals the consultant pitched in its draft report recommended the state look at going to downside risk.

Bailit Health consultants told the cabinet that according to “economic theory, individuals have a greater response to a risk of loss, than they do to the possibility of reward.” Applying that economic theory to health care, “it’s reasonable to expect that providers will be more responsive to improving care delivery if they are in a shared risk arrangement, rather than in a shared savings arrangement,” Bailit concluded.

But advocates reminded state officials that they promised not to implement a downside risk payment reform on the Medicaid population. The planning documents submitted to the federal Centers for Medicaid and Medicare Services stated that “There will be no downside risk,” applied to the Medicaid population.

“It’s a big experiment. Let’s not put you and me in this program unless we know it’s safe,” Sheldon Toubman, an attorney with New Haven Legal Assistance, told Wyman.

After the meeting Wyman clarified her remarks and said they wouldn’t consider implementing downside risk until the State Innovation Model grant expires in 2019.

“It’s not off the table. Nothing is off the table,” Wyman said.

She said the cabinet will be discussing it and there’s nothing the current administration can do in order to force future administrations from considering it.

“We don’t see the promise as being that limited,” Toubman said.

Toubman and other advocates who have opposed downside risk are not going to be happy that it’s still under consideration into the future.

“It is not consistent with the promises previously made by the administration, which they say they want to honor,” Toubman said. “It also would be destructive to the universally recognized success the Medicaid program has had in both improving access to care and saving money for Connecticut’s taxpayers, without putting that kind of harmful risk on providers. It baffles me why they would want to threaten this success.”

The Health Care Cabinet is expected to adopt its final recommendations for cost-containment and payment reform that will impact the entire healthcare system on Nov. 1.