In the latest development in Alabama’s ongoing struggle to pass a state budget, Governor Robert Bentley has indicated that he will consider what cuts he could make to the state’s Medicaid program before calling a special session of the legislature. Included on the chopping block is elimination of the state’s Regional Care Organizations, which are designed to improve care to Medicaid recipients, as well as prescription drug coverage for all adults.


The California Department of Health Care Services (DHCS) hosted a webinar on April 7 to discuss a number of proposed changes aimed at strengthening the quality of care and promoting sustainable enrollment in Cal MediConnect, the state’s dual eligible demonstration project. Among the proposals are:

  • Program improvements for 2016 aimed at strengthening long term services and supports (LTSS) referrals and care coordination, sharing best practices and ensuring all plans are performing to the highest standard and strengthening continuity of care;
  • Expanding enrollment by using annual passive enrollment, operationalizing mandatory MLTSS Enrollment, exploring the extension of the deeming period and conducting targeted provider outreach; and
  • Streamlining the voluntary enrollment experience.

DHCS is accepting comments on these proposals until Friday, April 22.

Covered California, California’s health insurance marketplace, recently unveiled sweeping reforms that aim to improve quality of care, curb health care costs and increase transparency for consumers. One initiative in particular will require Qualified Health Plans selling insurance in the exchange to reduce health disparities for their enrollees starting in 2017. Community Catalyst partners at the California Pan-Ethnic Health Network and Health Access California have been actively supporting this initiative, among others. The new initiative will provide plans with incentives for showing year-over-year improvement in key target areas where disparities are well-documented: diabetes, hypertension, asthma and mental health. In other California news, the Center for Health Care Strategies recently released a profile that describes an innovative pilot program designed by the Health Plan of San Mateo to help dually eligible individuals in nursing facilities transition back to community living and support those at risk of nursing home placement to remain in the community.


The Commonwealth’s Health Policy Commission has released a special report on provider price variation. Key findings include:

  • Provider prices continue to vary extensively and such variation has not diminished over time;
  • Market leverage rather than quality variations continue to be a significant driver of higher prices;
  • Unwarranted variation in prices combined with the large share of volume at higher-priced providers results in increased health care spending and creates inequities; and
  • Unwarranted price variation exists in other states, but where a state limits hospital price variation to value-based factors, there is less price variation.

An article in the Boston Globe describes proposed changes to MassHealth, the state’s Medicaid program. Under this plan, MassHealth beneficiaries would be placed into Accountable Care Organizations in which doctors and hospitals are paid set budgets to treat patients. The state proposes to begin enrolling beneficiaries into the ACOs beginning in October 2017. The proposal is subject to approval from the Centers for Medicare and Medicaid Services.

New York 

The state of New York has released enrollment and disenrollment guidance for the dual eligible demonstration project for persons with intellectual and developmental disabilities (FIDA IDD). The FIDA IDD demonstration is a voluntary program and will not use passive enrollment. Eligible enrollees were able to begin opting into the program on April 1, 2016.

The Centers for Medicare and Medicaid Services (CMS) approved New York’s state plan amendment for children’s health homes on April 7 and conducted a webinar that outlined the conditions of the amendment and provided an update on the children’s Health Home implementation. The implementation date for the program has been postponed to Oct, 1, 2016. The rate structure approved by CMS will be in place for two years, at which point CMS will review the rate structure again.


Two counties in southwest Washington State began a new program on April 1 to fully integrate physical and behavioral health services – including substance use disorders services – for nearly 100,000 Medicaid enrollees. By January 2020, the entire state is slated to have moved toward a fully integrated physical and behavioral health care system for Medicaid beneficiaries. If the integrated program is successful, the next step will be to involve community-based organizations to address the social service needs of this population.

The Washington state Legislature has come to agreement on a supplemental budget that includes funding to maintain and expand the state’s Health Home dual eligible demonstration project. The budget also significantly increases funding for mental health services.


The state has issued a Request for Proposals for a Medicaid ACO program. This program, which is slated to begin January 2017, is based on the Centers for Medicare and Medicaid Services’ Next Generation ACO Model.