The Centers for Medicare and Medicaid Services has approved an 1115 waiver request from the state of Alabama that will allow it to move forward with a new managed care program for its Medicaid enrollees. The waiver will allow Alabama to create 11 Regional Care Organizations (RCOs) that will enroll Medicaid beneficiaries and seek to improve care and cut costs. The waiver agreement could bring almost $750 million into the state to care for low-income Alabamians.


The Department of Health Care Services recently released an All Plan Letter providing Medicaid managed care organizations (MCOs) with guidance on what is expected from them when a provider – such as a nursing facility – is decertified or terminates its MCO contract. In order to minimize beneficiary disruption, MCOs are now required to provide the state with a beneficiary transition plan. The plan must include a process to consult with the Long-Term Care Ombudsman, a process to work with the beneficiary regarding the transition and a timeline to contact the MCO plan beneficiary. This policy change came as a result of advocacy by the Long-Term Care Ombudsman Program (Wise and Healthy Aging in Los Angeles), Justice in Aging and the Coordinated Care Initiative ombudsman.


On Jan. 29, the Long-Term Services and Supports (LTSS) subcommittee of the One Care Implementation Council held a public meeting to discuss the provision of LTSS to enrollees in the One Care dual eligible demonstration project. Attendees included several LTSS coordinators who reported increased challenges in: (1) getting authorizations from plans for needed services; and (2) case manager communication with enrollees and LTSS coordinators.


Community Catalyst blogged about a study released by our long-time partner, the Maryland Citizens’ Health Initiative (MCHI), that looks at examples of collaborations between hospitals and faith/community-based organizations. We encourage advocates seeking to develop similar kinds of projects to take a look at the research MCHI has compiled.


In 2015, Minnesota’s governor and Legislature created the Health Care Financing Task Force to advise policymakers on strategies to increase access and improve the quality of health care for Minnesotans. The task force workgroups include representation from consumer health advocates, including TakeAction Minnesota. The task force voted to approve a package of 33 recommendations with strategies for enhancing data sharing, supporting integrated care delivery, and enhancing health system transformation pilots, demonstrations and existing programs.

New York

The New York State Department of Health has provided some interesting dashboard information on enrollment trends in the state’s dual eligible demonstration project. 


In its latest blog, UHCAN Ohio launched a consumer survey that will help Ohio health plans design ways to help members stay healthier while reducing costs through the use of Value-Based Insurance Design (V-BID). Some health plans, including those run by state retirement plans, are experimenting with V-BID by reducing co-pays on the treatments that people with chronic illness need the most to stay healthy – “high-value” treatments– and raising co-pays on treatments that are considered “low-value.”  

In a similar vein, lowering costs and improving care is the goal of the state of Ohio’s State Innovation Model (SIM) grant. UHCAN is working within Ohio Consumers for Health Coverage to represent consumers at the SIM table and introduce consumer-oriented strategies like V-BID.


Pennsylvania  is expected to release a request for proposals (RFP) this month for Community HealthChoices, the state’s managed long-term services and supports (MLTSS) program. The program will first be rolled out in southwest Pennsylvania in 2016, with enrollment and services effective Jan. 1, 2017. It will be launched in the southeast region in January 2018 and in the northwest, Lehigh-Capital and northeast regions in January 2019.

South Carolina

Healthy Connections Prime, the state’s demonstration project for dually eligible beneficiaries 65 and older recently notified providers that the first wave of passive enrollment will begin in April 2016, affecting beneficiaries in twenty counties. To date, almost 2,000 members have voluntarily enrolled in a Coordinated and Integrated Care Organization (CICO) within the demonstration project. The second wave of passive enrollment will begin in July 2016, affecting beneficiaries in 19 additional counties. 


The state of Vermont released an overview of its proposal to CMS for an all-payer model that would distinguish itself by setting spending targets for almost all health care services rather than being limited to hospital care.


Last month, the state submitted an 1115 waiver  to the Centers for Medicare and Medicaid Services (CMS) to transform its Medicaid program and move the state’s most vulnerable populations into managed care. The waiver seeks CMS approval to shift the state’s blind, elderly and disabled populations—including those with both Medicare and Medicaid—into capitated health plans. If approved, this move would result in the end of Commonwealth Coordinated Care (CCC), the state’s dual eligible demonstration project next year. The waiver also seeks approval to implement a Delivery System Reform Incentive Payment (DSRIP) program. This would allow the state to use federal Medicaid funding to create financial incentives for providers to pursue a variety of delivery system reforms. 

In the meantime, the Department of Medical Assistance Services released the latest enrollment dashboard  for the CCC as of January 2016.