Tue May 8, 2012
State Prepares for Massive Shift to Medicaid Managed Care
News Update at 2:54 p.m. Wed. May 9: The Executive Council has passed a $2.3 billion contract that will overhaul the state’s Medicaid program. Medicaid Managed care could significantly shake up service for some 140,000 N.H. residents. HHS officials believe this reform is critical. More details to follow on this evening's All Things Considered.
Many state officials believe the change will improve services, save money and simply better position the program going forward. But advocates for the developmentally disabled say this contract threatens vital care that thousands of residents receive.
Think about a house, a house that’s got a leaky roof, busted out windows, no insulation. It needs serious work, and the homeowner is paying through the nose just to stay warm and dry. That’s one way to think about the state’s current Medicaid program, which serves some 140,000 New Hampshire residents.
Using that analogy, Health and Human Services Commissioner Nick Toumpas says shifting to Managed Medicaid will be like Extreme Home Makeover.
“With better energy, better windows, that are more energy efficient, a better layout that will allow us to be as efficient as we can,” Toumpas says.
He believes one of the ‘home’ improvements that must be made is to change how the Medicaid program deals with the developmentally disabled. This group makes up a small fraction – 6% - of the entire program population, but they drive 25% of total costs.
Toumpas says fundamental to building this better Medicaid system is connecting the typical medical services a person receives -like a visit to the doctor - to the long-term care they get - like an aide coming to the house.
“There is no linkage, there is no case manager, there is no management of the care of the medical side of it as well as those essential services.”
To Toumpas, getting that case manager is like fixing the broken windows. And this is where Toumpas believes the state can really realize significant efficiencies. He says those efficiencies will lead to savings.
There’s just one thing.
Toumpas says, “We don’t have a detailed plan.”
This is where the department’s ideas about reforming care for the disabled hits some bumps.
Over the 1000-odd page contract, less than a page is devoted to this idea of merging medical care with long-term care needs. On top of that, the three companies that would run the Medicaid program - Boston Medical Center Health Plan, Centene and Meridian – don’t have any real experience doing it.
“There’s a long road ahead of us on this."
If and when the contract is approved by the Executive Council, Toumpas says he’ll bring the department together with managed care companies and the families and providers who serve this population.Together, the commissioner says, this team will devise a plan to ensure the some 12,000 New Hampshire residents will be taken care of.
But not everyone is so confident that this transition will work out. Jennifer Bertrand's 12-year old daughter Chloe is autistic, and needs about 20 hours a week of in-home help.
She says, “If it’s not in writing, what will these out of state managed care organizations have to say about that?”
Bertrand and hundreds of other families who could be affected by the change are irate HHS is seemingly giving managed care companies carte blanche.
No plan, no experience working with this population, but we are guaranteeing that these firms will get hundreds of millions of dollars in taxpayer money.
“Our current system is like a Main St. system, it’s around the corner, people that you know. People that are passionate about providing quality services." Bertrand says, "and I just, I’m worried about the quality of care being compromised. I’m worried about an out-of-state company looking at my daughter as an individual, looking at her as a commodity.”
Bertrand says parents plan to line the statehouse halls as the Executive Council meets to decide the fate of the managed care contract. She says they will be armed with tissue flowers representing individuals with developmental disabilities. According to Bertrand many families want the council to scrap this contract, and start over.