Massachusetts: MassHealth Releases Draft 1115 Waiver Amendment and Extension Request

The Massachusetts Executive Office of Health and Human Services released a draft 1115 waiver amendment and extension request to transition its Medicaid program (MassHealth) to a Medicaid Accountable Care Organization (ACO) model that emphasizes partnerships among provider ACOs, Medicaid managed care organizations, community-based organizations, and social service agencies. The proposal requests $1.8 billion for a Delivery System Reform Incentive Payment (DSRIP) program to: support ACO implementation; stabilize safety net hospitals; fund "flexible services" that address social needs not otherwise covered by publicly-funded programs; support infrastructure development for behavioral health and long-term services and support organizations operating in partnership with ACOs; and support statewide infrastructure and workforce investments. DSRIP funding would be subject to a statewide 2.5% Medicaid cost reduction target for ACO members as well as quality, ACO adoption and avoidable hospital utilization measures. ACO DSRIP funding would be increasingly risk-based over the life of the waiver subject to quality, cost and member experience measures, as well. The waiver also requests an additional $6.2 billion for a restructured Safety Net Care Pool, increasing accountability for funds historically dedicated to safety net providers. The existing waiver runs through July 2019, though funding for the current $1 billion per year Safety Net Care Pool was only approved through July 2017, in part prompting the State’s advance request for a five-year extension through 2022. The draft waiver is open for public comment until July 15.

Wisconsin: Major Proposals to Alter Medicaid Long-Term Care Programs Withdrawn

Department of Health Services (DHS) Secretary Kitty Rhoades informed the Legislature’s Joint Committee on Finance that planned changes to Medicaid long-term care (LTC) programs, initially scheduled to take effect in January 2018, were to be withdrawn entirely. Governor Scott Walker's (R) administration had estimated that shifting LTC contracts to managed care through regional integrated health agencies would produce $300 million in savings, or 1.7% of LTC spending over six years. The rescinded proposal involved significant changes to the Family Care and the “Include, Respect, I Self-Direct (IRIS)” programs, which function to keep more than 55,000 elderly and disabled out of nursing facilities and in their homes, and accounted for nearly 60% of LTC spending this fiscal year. Strong opposition to the proposal was voiced over the course of 10 public hearings, including concerns about reduction in services and increased barriers to access LTC.