Earlier today, the Executive Council approved the largest contract in state history.
On a 3-2 vote, the Council approved a $2.3 billion deal to overhaul the state’s Medicaid program.
State officials say the move is essential to preserving a program that provides health and social services to about 10% of the state’s neediest residents.
Critics worry the shift to managed Medicaid could lead to less care, compounding severe hardships.
A new era in social policy has begun in New Hampshire.
Dan Gorenstein (DG): In Commissioner Nick Toumpas’s mind, hiring companies to run the state’s Medicaid program isn’t really a choice.
He says the program – which provides a wide variety of services to everyone from low-income mothers and their children, to the mentally ill, to senior – is NOT sustainable.
Toumpas: “Now, I’ve got a shrinking pie in the face of increasing demands. Something is going to give. “
DG: Had the state not moved to managed care...where do you believe our Medicaid program would be 5 years out, 10 years out, 20 years out?
Toumpas: “In a world of hurt. I don’t mean to be flip about it. but we have an aging population, a number of people who are uninsured, we have every provider group that basically says I am not being paid enough for the services I provide.”
DG: In other words, to stop limping along Toumpas believes radical change is required.
And in this case, the radical change is managed Medicaid.
The commissioner says there are things the managed care companies can do that the state can’t do nearly as well.
The firms - Boston Medical Center Health Plan, Cetene and Meridian – can help patients make better choices about their care, staying out of the emergency room, for example.
The companies can negotiate better rates.
The firms are looking to modify how they pay for services.
Steve Norton with the New Hampshire Center for Public Policy Studies says these reforms could strengthen the state’s Medicaid program.
Norton: “In some places managed care has improved quality and lowered cost. Can we expect a similar path in New Hampshire? I think the evidence suggests when you implement managed care in a careful way, you have savings and potentially improvements in quality.”
DG: Health and Human Services knows it has a lot of work to get this program off the ground.
It’s not projected to be up and running until the late fall, or later.
Deb Fournier with the New Hampshire Fiscal Policy Institute says there are some critical questions the state must answer in the short-term.
Fournier: “We want to make sure those are tight and appropriate so the state can conduct its really important job of managing oversight of these contracts. Because that will be a huge component of whether these contracts are successful.”
DG: Another marker of success is how the state handles some of the most vulnerable and expensive Medicaid members.
HHS has included long-term care services for seniors, the developmentally disabled and people with mental illness in the managed care plan.
Few states have taken this step, and managed care companies across the country have little experience in this area.
The financial incentive is clear.
These three groups make up about 30% of the Medicaid population, but drive 70% of the costs.
But there is no plan telling companies how to work with the disabled and elderly.
That’s left people like Karen Salter – whose 25 year old son needs daily assistance due to a genetic disorder – terrified.
Salter: “It’s my life. My life is centered around his life. And anything that affects his life, I’m his primary caregiver, I’m his mom and I’m his guardian. I will be in it for the long haul, as long as I physically can.”
DG: If her son’s care is reduced, that could force Salter to quit her job.
More than that, it could threaten the quality of life she’s strived to build for her boy.
Now that that state has finally committed to managed Medicaid, Commissioner Toumpas is calling the families, the advocates, the managed care companies to come up with a plan.
He also hopes now there will be an acceptance that this is the new path.
For their part, providers for the developmentally disabled say they are considering legislative and legal action.