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Concerns raised about Medicaid managed care program’s effect on quality of care

Last modified: 2/13/2015 12:56:14 AM
The schedule for the next phase of New Hampshire’s transition to Medicaid managed care is set for some, but not all, of the remaining groups of people who still have to transition into the program. And as the state moves forward on this and other elements of the transition, families and advocates are continuing to raise questions about the program’s overall effect on the quality of care.

The transition to managed care has been a multiyear, multibillion-dollar undertaking for the state. Moving away from its traditional fee-for-service model, New Hampshire has contracted with two companies – New Hampshire Healthy Families and Well Sense Health Plan – to coordinate services and related payments for its Medicaid populations. Health and Human Services Commissioner Nick Toumpas said the state is looking into the possibility of contracting with a third company, but that’s still preliminary.

The goal of the program, as articulated by state officials, is to move toward a “whole person approach” to Medicaid services while also slowing down the rate at which costs for these services are increasing. Along the way, others have repeatedly raised concerns that this move would have – and now, is having – a detrimental effect on some of the most vulnerable families affected by the changes.

Step 1 of the state’s managed care program began in December 2013 for some of the state’s Medicaid recipients. At that time, enrollment was optional for several Medicaid populations: those in nursing facilities, those receiving services through the Choices for Independence Waiver, those with developmental disabilities and acquired brain disorders, and others with medical conditions requiring in-home support.

Since then, there have been multiple changes to the Step 2 timeline – including several within the last six months. At a meeting of the House Finance Committee last month, Toumpas said the delays in implementing the second phase of the program added about $9.6 million to the agency’s budget shortfall. (The department has since unveiled plans to address its budget hole.)

Under the timeline presented at yesterday’s meeting of the Governor’s Commission on Medicaid Care Management, those who previously had the option to opt out of the program will begin enrolling July 1. From there, medical coverage for the different populations will begin in September.

“People who have Medicaid and Medicare, or who are dually eligible, have the option of enrolling for their medical care through a managed care organization,” Developmental Services Bureau Chief Lorene Reagan said. “What we would see on July 1, 2015, is that the groups who were previously optional – those folks who had opted out – would now become mandatory for their medical care in the program.”

Managed care coverage for people receiving Choices for Independence waivered services will begin Jan. 1, 2016. That coverage was previously on track to begin in September.

Managed care coverage for nursing facilities, which was also supposed to begin in September, will now be delayed until July 1, 2016. And managed care for community-based services for children within the Division of Children, Youth and Families will also begin at that time.

The state still has to figure out when coverage will begin for Medicaid recipients with developmental disabilities and acquired brain disorders, as well as others who require in-home supports.

As families and advocates for the populations affected by the changes await further details on what to expect out of the future of the program – and what it might mean for their loved ones – some said they’re losing faith in the department’s ability to hear out their concerns.

Some remain upset at the mixed signals they received from the state about who would be required to participate in managed care. Others are frustrated by persistent denials of requests for therapies or prescriptions – a problem the state has acknowledged and is monitoring closely. This move that was supposed to increase coordination has, in some cases, placed added burdens on families who are left to negotiate through appeals processes and other complications.

“Everything is being shifted back onto families whose lives at best are already tenuously balanced,” said Cathy Spinney, who serves on the New Hampshire Developmental Services Quality Council and is a parent of a child who is affected by the Medicaid changes. “Families have had it. This is stuff they’ve never had to fight for, they don’t understand, they can’t get through to the people they need to.”

Spinney, on behalf of the quality council, presented a detailed set of recommendations to the commission for ensuring that the quality of the services people are receiving through Medicaid remain protected amid the state’s changes.

The department has held a series of public forums at multiple stages of the program’s transition, and officials have said they will continue to welcome feedback as the program moves forward. At the meeting, Toumpas and several members of the commission said they wanted to hear when people are having problems with managed care so that they can figure out possible fixes.

(Casey McDermott can be reached at 369-3306 or or on Twitter @caseymcdermott.)


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