While Utah’s current Medicaid program survived the just-completed legislative session largely intact, budget-related actions by the House and Senate left Medicaid significantly underfunded.  UHPP’s 2012 Medicaid Budget Scorecard (see it here) shows where 2012 supplemental and 2013 funding comes up short.  The bottom line?  The Utah Legislature once again failed to fully fund Medicaid and CHIP caseloads, so the Department of Health will be back next year with a supplemental request to make up the difference.  The Utah Legislature also scaled back the funding requested by the Department to strengthen its ability to oversee and manage the transition to accountable care.  In addition, the longer-term budget picture for Medicaid and CHIP was clouded by the Legislature’s passage of SB208, Health Care Compact (read more here).

The Majority Caucuses are recommending significantly less funding in critical Medicaid areas, going against consensus budget forecasting and Social Services Appropriations Subcommittee recommendations.

Topping the list of casualties are ongoing funding for Medicaid caseloads ($47 million, down from $68.2 million), one-time funding for Medicaid caseloads ($35 million, down from $44.3 million), and accountable care full risk funding ($2 million, down from $3.1 million per the agency’s minimum request).

The two caucuses have yet to reach consensus on 2 building blocks: the waiting list for DSPD waiver services and Rep. Menlove’s autism spectrum disorders pilot bill (HB 272).

Underfunding Medicaid caseload will weaken the state’s ability to create the most competitive market possible for the business the state contracts to health plans.  Health plans want to know that once they commit to being on the hook for Medicaid costs, as they would be under accountable care, the state is not going to pull the rug out from under them by not fully funding caseloads.  The caucuses’ recommended caseload funding levels just aren’t good business practice.

The Department of Health will not be able to take the first steps toward accountable care at the caucuses’ recommended funding level for payments to health plans.  When health plans take all the risk, they get paid a set amount each month to provide health care to their enrollees.  They get paid up front.  Without the money to pay the plans up front, the Department won’t be able to get the plans to take the risk.  Paying the plans up front gives them the incentive they need to make accountable care work.

Right now, only one of the plans is on the hook for costs.  If costs come in below what the state pays them, the plans keep the difference.  If their costs are higher than what the state pays, they eat the loss.  Moving to accountable care will mean the other plans will be on the hook in the same way.

Not funded at any level under the caucuses’ recommendations are the restoration of adult dental ($3 million), eyeglasses ($250,000), and adult audiology ($150,000).  Many Utahns enrolled in Medicaid who want to work can’t because they have vision or hearing problems or the appearance of their teeth rules them out for jobs where they would interact with customers.  Utah talks the talk about getting those Utahns enrolled in Medicaid who aren’t working back into the workforce.  It’s time we walk the walk by restoring these services.

WHAT CAN YOU DO?  

Contact members of Executive Appropriations listed here and urge them to support full funding for Medicaid caseload growth, accountable care payments to health plans, and restoration of eyeglasses.  These are all important tools in the accountable care toolbox for reducing the growth in Medicaid costs!

The idea of providing health coverage for more Utah children seems to be rather unpopular at the 2012 Legislative Session.  SB111, Health Amendments for Legal Immigrant Children (Sen. Robles), is still trapped in the Senate Rules Committee.  Senate leadership has made it clear they are not interested in having an open debate on this sound health policy that would build on the success of State Health Reform.

SB111 would lift the 5-year waiting period for children who are Legal Permanent Residents to qualify for Medicaid or CHIP. Those five years make a big difference for the wellbeing of children.  See UHPP’s SB111 fact sheet here.

Many individuals and organizations, including the Utah Chapter of the American Academy of Pediatrics, Primary Children’s Medical Center, United Way, and the PTA have shown support for this bill. Unfortunately, these efforts appear to be in vain.  We are holding an emergency meeting this Tuesday, February 14, at 12:15 pm in room 250 of the Senate Building to bring together all supporting groups and individuals to make a decision on what should be done next around SB111.

We can all agree that ALL children deserve access to health care. The question is how can we get this message across? Let’s talk about it at our meeting on Tuesday.

When the U.S. Congress reauthorized CHIP funding in 2009, they included a provision that would give states a sizeable bonus if they could make the enrollment process more efficient in at least five of eight categories.  As of April of this year, Utah will have met that goal!  Utah’s improvements include eliminating the requirement to do an in-person interview, ensuring that questions on the application and renewal forms for Medicaid and CHIP are the same, and allowing children leaving foster care to keep their coverage when they go into the community.

If all goes according to plan, Utah will receive a bonus of $17 million for each of the next two years from the Center for Medicare and Medicaid Services.  The best news of all is that the bonus money will be used to cover more kids!

CALL TO ACTION!!  PROTECT MEDICAID AT THE SUPERCOMMITTEE LEVEL

Tasked with finding a minimum of $1.2 trillion to help close the deficit, the Super Committee of the United States Congress is approaching their deadline of Wednesday, November 23^rd to finalize a deal.  Predictably, the committee is deadlocked over new revenues and tax increases on the wealthy.  What is going unnoticed by many is the looming threat to entitlement programs such as Medicaid and Medicare in the form of cuts.  One proposal, the “compromise” put forth by Erskine Bowles, would include $600 billion in cuts to Medicaid and Medicare.  According to the nonpartisan Center for Budget and Policy Priorities, this “compromise” goes much further than even House Speaker John Boehner’s original proposal by, among other things, raising the Medicare eligibility level to age 67.  Bowles claims these individuals would be covered through the premium subsidies included in the ACA (federal health reform). Not necessarily, say the analysts at CBPP; depending on how the Supreme Court rules in 2012 or on results from the 2012 election, this could be a risky proposition for the older Americans who rely on Medicare for their care. By shifting costs to other parts of the health care system, the Bowles plan merely adds to the total burden that health care places on the economy (Click  here and here for details).

NOW IS THE TIME TO ACT. These proposed cuts are not yet law—it is not too late to talk to your representatives to tell them these cuts are unacceptable.  Families USA is hosting call-in days from November 15-17 urging people across the country to tell members of Congress, ”Don’t cut Medicaid!”
Please feel free to use Families USA’s toll-free number to the capital switchboard: 1-866-922-4970.

Message to Congress:
Urge all members of Congress to reject any cuts to Medicaid. As the super committee considers how to reduce the nation’s deficit, send the message that any final deficit reduction package must be balanced and include significant revenue increases. Click here for additional talking points that might help you shape your message.

Just because Utah does not have a seat on the Super ommittee, doesn’t mean that our delegation (Congressman Matheson mainly, who could be persuaded to weigh in with his Super Committee colleagues) shouldn’t be engaged on this issue.  See helpful tips for
communicating with members of Congress.

Social Services Appropriations Committee on 10/20 to frame decisions in 2012 General Session  

You will want to make every effort to attend Thursday’s special all-day, off-site (Davis County) sessions scheduled for this committee, starting at 8:00 AM (Davis Local Health Dept), with a break for lunch, and picking up again at 1:00 pm at the DWS office in Clearfield.  Get both packed agendas here.

It’s no mystery why the SSA (Social Services Appropriations) Committee is assessing the strength of the safety net at this time:  some members are looking ahead to a still shaky revenue outlook for the 2012 session and want to learn more precisely where they might shrink the role of government in addressing human needs.  Others, noting the mounting pressures to fund public education and other worthy line items, may be looking for better control and more data to drive budgetary decision-making.  No
matter what the motives, we should be thankful for the opportunity to frame the issues and choices before the SSA!

The SSA Chairs have requested that individuals with experience receiving, applying for, or providing services to low income people share what is working well and what is not for low income individuals. The fiscal analyst compiled a list of the entire safety net and invited all of these agencies to testify.  If your agency is on the list, please make every effort to attend. If you provide any health-related services, please touch on the importance of full funding for Medicaid and touch on the principles and recommendations below for sustaining the state’s investment in the program.

This year’s draft principles are threaded through the current Medicaid  “moment” (payment and delivery system reforms and more fraud to go after) to help you flesh out the need for full Medicaid funding and cost containment measures to sustain worthy Medicaid investments.

Draft Principles (to be refined at CRITICAL Utah Medicaid Partnership meeting on Tuesday 11:00 AM
Catholic Diocese):

1.      The structural deficit should be addressed, but not all at once and not at the expense of Medicaid, which supports decent local jobs and, by virtue of the infusion of federal dollars, serves as an
economic driver.  In meeting health care needs that would otherwise go unmet, Medicaid is all about cost avoidance.

2.      To limit growth in Medicaid spending, dig deeper into payment and delivery system reforms…

• draw on local expertise to develop outcome measures and standards for evidence-based care. One year past passage of SB180, Utah has yet to start down this path.
• maximize federal opportunities, such as medical home demonstration grants, to go after the big cost centers in Medicaid: treatment for two or more chronic conditions and dual eligibles.
• Embrace initiatives to integrate mental health care in primary care settings—why wait when the status quo is so expensive?

3.      In the meantime, maximize cost containment opportunities in Medicaid:

• Build the necessary safeguards and grandfathering provisions to expand the preferred
  drug list to certain psychiatric medications.
• Develop legislation to adjust or vary the hospital payment to reward hospitals’ efforts to minimize preventable hospital re-admissions and patient complications.
• Savings in the tens of millions can be realized in 6 months or less.

4.      Leave no stone unturned in addressing waste, fraud, and abuse within Utah Medicaid…

• Enact SBXXX (Sen. McAdams) False Claims Act (Qui Tam) to engage upstanding citizens and the private sector in reporting fraud and abuse.
• Make sure the Department of Health has adequate staff to detect and prevent waste
  and fraud—right now they don’t.

5.      Recognize Medicaid’s value and role as a critical safety during the jobless economic recovery.  Tax revenues follow the business cycle, but countercyclical programs like Medicaid naturally
grow as unemployment rises, incomes fall, and job based insurance declines.  Medicaid and CHIP are needed now more than ever to help families get back on their feet.

Thank you and see you TODAY & Thursday!

Since the beginning of the recession in late 2007, Medicaid has lost a number of critical services for people with disabilities, low-income seniors, and parents, including dental, vision care and audiology.  None of these services were considered for restoration this session—in fact, it may not have escaped your attention that the entire Social Services Appropriations process was orchestrated to consider solely what cuts could be made.

 In order for Medicaid to provide high quality care as cost-effectively as possible, these services must be restored.  With state revenues likely to grow in the coming year, it is time to push for a more comprehensive and data-driven approach to prioritizing building blocks.

 Over the next year we will try to build our case for these services into the emerging Medicaid reform process.  In the scheme of things, the cost of these services is minimal, yet the benefits they bring in terms of cost avoidance, care, and disease management could make them critical to the success of the proposed accountable care organizations.

Medicaid’s Fiscal Imbalance —Hope on the Horizon in Senate Bill 180

In the last two sessions the Legislature has funded Medicaid enrollment growth using one-time and ongoing funds.  However, there is no indication that enrollment in Medicaid is slowing down. In fact, all indications suggest enrollment will continue to grow through FY2012.  But there is hope on the horizon: Senator Liljenquist was able to pass his SB180 Medicaid Reform all the way through the process.

 SB180 will fundamentally reform the way Medicaid services are paid for and delivered in Utah—and not a moment too soon.  Key provisions of SB180 include the creation of Accountable Care Organizations (ACO), a bundled payment system based on a per member/per month spending cap, and a new Medicaid Rainy Day Account as a repository for any savings that may be generated by the proposed payment reforms.  While the overall intent of SB180 is positive, critical details have yet to be seen, and some of the language on spending caps and expectations for consumer behavior sets off alarm bells.  Still, payment reforms for Medicaid cannot wait another day, and SB180 may be the best way forward.  To read more about Medicaid Reform click here.

The Dahlquist Family: A CHIP Success Story.

Utah Medicaid survived largely unscathed this session.  With higher than projected revenues this year, the budget was brought into balance without any cuts in eligibility or services.  For a good part of the Session we stood to lose access to cost-effective breast and cervical cancer treatment for low-income women, interpreter services, hospice care, and dental and vision care for low income pregnant women.  Fortunately, by the end of the process ongoing funding was found to keep these programs intact.

Carol Pastor (patient served by the Medicaid Breast and Cervical Cancer Treatment and Prevention Program) with Dr. Brent Parkinson (radiologist and Director of Intermountain Medical Center’s Breast Care program).

Medical interpreting kept falling off the backfill list—until we brought in teams of physicians and interpreters…

Primary Care Grants funding ($400,000 of the $1.2 million total) has fallen off of the list to be backfilled! The goal of the State Primary Care Grants Program (SPCGP) is to increase the number of individuals with access to appropriate, high quality, and cost-effective primary health care.  This program serves Utah’s low-income families that do not have health insurance or have insurance that does not cover primary care services.  The program provides these families with a “medical home.”  Individuals with a medical home are more likely to be diagnosed early, receive appropriate care, and report satisfactory outcomes.

In fiscal year 2011 $1.2 million in SPCGP funds served 45,000 people.  Here’s a break-down on the types of services by category and the amounts associated with each:

Patients served through the SPCGP pay a sliding-fee scale fee for the services they receive. Also, a good portion of the money for primary care (at least at health centers) provides subsidies for quality prenatal care and chronic disease management.  For the total amount allocated for “primary care” ($608K), for example, there is a significant return-on-investment, and this is illustrated by the fact that one pre-term, low-birth weight, or baby born with severe complications due to inadequate (or no) access to prenatal care will cost the state much more than the $608K allocated to primary care  under this program.

YOU CAN HELP educate members of the Executive Appropriations committee about the critical role that the SPCGP plays. Please ask them to backfill the full $400,000, while protecting Medicaid items already backfilled.  Such a cut could have costly consequences, as clients would then be utilizing the ER for their care, shifting costs to the State.

During the day…

• Call Senators at (801) 538-1035. Toll free: (800) 613-0677.
• Call Representatives at (801) 538-1029 Toll Free: (800) 908-4261

 Legislative Leaders (Executive Appropriations Committee)

Download the latest Excel list (perfect for mail merge!) here.

Please urge members of leadership to keep this vital and cost-effective service in place. Here are a few talking points for you to use:

• This is a critical service for Utah’s many refugees and immigrants who are in the process of learning   English, but don’t yet speak well enough to ask important questions or understand medical instructions.
• If Medicaid reimbursement for medical interpreters is cut, providers will have to shoulder the task of both finding and paying for qualified medical interpreters (in over 40 languages!).  Many providers have told us that because Medicaid reimbursement rates are way below their costs, they already think of their Medicaid service as charity care. If they have to pay for interpreters they will not be able to afford to see Medicaid patients at all. 
• In addition, patients who can’t find a doctor who will take Medicaid, or can’t understand the doctor who does, will end up in our Emergency Departments where prices are higher, but interpreters are always available. For more information on this crucial program see our brief.

Steps you can take TODAY to protect Medical Interpreting

• Sign on to the Utah Medicaid Partnership/U-SHARE coalitions’ principles for guiding Medicaid budget decisions and handling the structural deficit. See the latest principles here. 
• Come up to the Hill, especially the Executive Appropriations meeting this Thursday at 5:00 pm being held in room 210 of the Senate Building. At the EA meetings committee members will be discussing and voting on the Social Services budget. Contact UHPP if you are interested in coming up to the Hill to speak with key members of the EA regarding the proposed cuts and backfilling the most crucial of these programs.