Medicaid commissioner: Alabama at ‘crossroads’ on Medicaid managed care switch
Medicaid Commissioner Stephanie Azar said Monday that the state is at a “crossroads” over whether to continue a proposed switch to managed care. Since 2013, Alabama has been working on a plan to shift some of the state’s 1 million Medicaid patients to managed care provided by Regional Care Organizations. The state pushed back implementation until Oct. 1 because of uncertainty over funding. Azar said federal Medicaid officials will withdraw the waiver if the state does not implement the regional care program by October. “We are at crossroads at the program. We can’t implement it any farther than Oct. 1. and funding, obviously, remains an issue for the program and our Medicaid program in general,” Azar said. Lawmakers approved the shift to managed care in the hopes that it would slow the growth of Medicaid expenses. She said the state Medicaid program will need an increase of about $44 million in the budget lawmakers will begin writing in the session that begins next week. Azar said she did not know what changes the Trump administration will being to Medicaid. “We don’t know what we don’t know,” she said. However, Azar cautioned that the state needs to play a role in any block grant design to make sure the state doesn’t end off “worse off.” Lawmakers used oil spill settlement funds to patch together Medicaid’s budget in 2017 and 2018. Azar said the money was a “god send” for the program. However, she said Medicaid faces a “train wreck” in 2019 without new revenue. Republished with permission of The Associated Press.
Jim Carnes: With federal health care threats looming, Alabama needs a doctor
If Gov. Robert Bentley still wants to be the doctor for Alabama, he has a good opportunity to prove it before Jan. 6. That’s the deadline that U.S. House Majority Leader Kevin McCarthy has given governors to respond to his letter asking them how best to “give all patients a fair shot at quality, affordable health care.” House Republicans already have laid out a vision of health care that falls far short of fair, high-quality and affordable. With their party set to take the White House next month, nothing stands in the way of their repealing the Affordable Care Act (ACA) as early as January. GOP lawmakers used to speak of “repeal and replace,” but the “replace” part is proving difficult. The “Better Way” plan they announced in June would strip Medicaid coverage from millions of low-wage workers, increase out-of-pocket health costs for many middle-income Americans and allow insurance companies to charge more to older enrollees and people with pre-existing conditions. But let’s take McCarthy at his word: If he does want advice, Bentley should offer some. The first point we urge the governor to make is that “repeal and replace” cannot mean “repeal and delay.” There’s something deceptively reasonable-sounding about pushing the effective date for repeal a couple of years down the road. After all, don’t ACA supporters want to delay the big changes as long as possible? Don’t be fooled: A ticking time bomb will not preserve the status quo. Once insurance companies see an end date looming for the ACA Marketplace, they lose their ability to plan ahead and likely will bail out of the Marketplace early. That would cost 195,000 Alabamians their coverage and disrupt the entire health insurance market. A second point is that converting Medicaid to a federal block grant – as many House Republicans favor – would be a disaster for Alabama. Medicaid is now a federal-state partnership that serves anyone who meets eligibility standards. Medicaid covers one in five Alabamians, almost all of whom are children, seniors, pregnant women, or people with disabilities. Alabama contributes only about 30 percent of its Medicaid program’s funding, with federal money covering the remaining 70 percent. Changing Medicaid to a block grant would limit Alabama’s federal Medicaid allocation to a fixed amount each year, regardless of the state contribution. Any cost increases would be borne by the state alone, with no 70-30 federal match. A Medicaid block grant would jeopardize health coverage for hundreds of thousands of Alabama children and seniors. It would leave our state’s Medicaid program with no protections against population growth or greater need during economic downturns or health emergencies. And it would imperil the Medicaid regional care organizations (RCOs) that Bentley has heralded as a way to save money and keep patients healthier by focusing on preventive care and early intervention. A related proposal to enact a per capita (or per-enrollee) cap on Medicaid funding would allow for enrollment growth, but it also would severely limit the program’s ability to respond to changing needs or pay for promising new treatments in the future. The cap also could open the door for new eligibility restrictions that would deprive more Alabamians of health coverage. Bentley is reconsidering his previous support for a Medicaid block grant, one of his aides told the Alabama Health Care Improvement Task Force this week, and he should be commended for that. We also hope Bentley recognizes the similar risks that a per-enrollee cap in Medicaid would pose for Alabamians, and that he will convey his concerns about both proposals to McCarthy. The holidays and the start of a new year are a time to reflect on what we’ve accomplished and what we hope to achieve in the year ahead. If the governor wants his legacy to be a healthier, stronger Alabama, he should stand against imminent threats to Medicaid and the insurance market and give Congress a strong prescription by Jan. 6. ••• Jim Carnes is policy director of Arise Citizens’ Policy Project, a nonprofit, nonpartisan coalition of congregations, organizations and individuals promoting public policies to improve the lives of low-income Alabamians. Email: jim@alarise.org.
State Auditor Jim Zeigler asks panel to delay $8M contract for Medicaid RCOs
Alabama State Auditor Jim Zeigler is asking for yet another Medicaid contract delay. On Tuesday, Zeigler asked the Alabama Legislature’s Contract Review Committee to delay a contract for $8 million in consulting services for implementation of the regional care organizations (RCOs) to deliver Medicaid healthcare. Zeigler said the contract needs to be scrapped, and has filed a written request for the maximum delay of 45 days to allow such action. “This huge consulting cost needs substantial review by all in authority,” Zeigler explained of his request. “A contract of this size does not need to be approved and should be scrutinized and scrapped.” Medicaid is seeking to pay $8 million to the Chicago firm of Navigant Consulting for implementing the new system of private providers in each area of Alabama instead of the present statewide administration by the state Medicaid agency. Zeigler continued, “It appears that the plan for regional care organizations as now formatted will cost the state millions instead of saving the state millions. This plan needs to be halted now, before millions are spent in the implementation stage. Approval of this contract would be throwing good money in front of bad.” Designed to be the state’s solution to the perennial problem of rising costs of Medicaid, RCOs have become a controversial topic in the Yellowhammer State this year. Last month, Zeigler filed a separate request for another delay of a controversial $1.3 million contract. The Committee approved the request for delay. The review panel will meet Thursday, Nov. 3 at 1 p.m. to review proposed contracts from state agencies, and will consider Zeigler’s request then. Below is a copy of Zeigler’s Nov. 1 request to the Contract Review Committee:
