« The Dual Agenda: January 14, 2016 Issue

State Highlights

California

Last week, California Governor Jerry Brown released the proposed 2016-17 state budget.  This proposed budget continues the state’s dual eligible demonstration project, the Coordinated Care Initiative (CCI), for two more years. The budget ties the future financial health of the CCI to passage of a new proposed tax on Managed Care Organizations (MCOs) and to improved participation in the program. If the tax is not approved and participation in the program does not meet growth goals by January 2017, the program will cease to operate one year later in January 2018.

In other news, Community Partners, with support from a consortium of foundations (The California Endowment, Blue Shield Foundation of California and Kaiser Permanente), is releasing a Request for Proposals on Jan. 15, 2016 to support up to six Accountable Communities of Health (ACHs) in California. The ACH model builds off prior efforts to explicitly bring together key sectors and partners – ranging from  community organizations to health care delivery system entities – in order to collectively advance a common health goal. This July 2015 report from the Prevention Institute highlights some of the opportunities and challenges of developing and implementing the Accountable Communities of for Health model.

Finally, in late December, the Center for Medicare and Medicaid Services (CMS) informed California state officials that they had signed off on the state’s $6.2 billion Medicaid waiver, including one year of extra funding for the state’s public safety net hospitals. The new waiver will allow California to sustain its Medicaid transformation program. Health Management Associates will host a webinar on this new waiver renewal and discuss its impact on Medicaid providers, plans and patients.

Massachusetts

MassHealth, the state’s Medicaid program, has posted the December enrollment report for the One Care dual eligible demonstration project.

In other news, Health Care For All submitted comprehensive recommendations to MassHealth regarding the development of Accountable Care Organizations (ACOs). ACOs represent a new way to pay for and organize health care delivery, by bringing together doctors, hospitals and other health care providers who work to give coordinated, high quality care to their patients. Check out Community Catalyst’s blog post about this important work.

New York

The state of New York is in the midst of designing an integrated financing demonstration program for dually eligible New Yorkers with developmental disabilities. In December, the Coalition to Protect the Rights of New York’s Dually Eligible (CPRNYDE) submitted comments regarding the state’s proposed plan.

In other news, New York state officials have released a Request for Proposals seeking a contractor who will conduct a multi-method, comprehensive, statewide independent evaluation of the state’s Delivery System Reform Incentive Payment Program (DSRIP). DSRIP is a $6.42 billion program and is the main mechanism by which New York is restructuring its Medicaid program, with the primary goal of reducing avoidable hospital use by 25 percent over five years. DSRIP initiatives are part of broader Section 1115 Waiver programs and provide states with significant funding that can be used to support hospitals and other providers in changing how they provide care to Medicaid beneficiaries. 

Oregon

In an opinion piece published in The Lund Report, Jesse O’Brien of OSPIRG, a  state partner of Community Catalyst, responds to a recently released New York Times report that puts the spotlight on health care prices. OSPIRG raises several questions about whether Oregon policymakers are doing enough to deal with rising health care costs and examining whether health care providers are shifting coststo insurers  to make up for inadequate public payor reimbursements.