Manatt Health released a new report for the California Health Care Foundation that looks at potential pathways for delivery reform within Medi-Cal, the state’s Medicaid program – the largest in the nation.. The report provides an overview of the Medi-Cal landscape, shares perspectives from Medi-Cal stakeholders, assesses key challenges and opportunities, and articulates a route for advancing Medi-Cal delivery system and payment reform.


As reported previously, MassHealth, the state’s Medicaid program, has released for public comment its 1115 waiver proposal. The proposal would move /> the state’s Medicaid enrollees into one of three different <a href=Accountable Care Organization models as part of the state’s efforts to move to a value-based payment system. Advocates are mobilizing around the proposal in order to assure it meets beneficiaries’ needs. Public comment on the proposal is due July 17. In addition to accepting written comments, the state conducted two public listening sessions on June 24 in Boston and June 27in Fitchburg. Advocates, including Health Care for All, testified on the pros and cons of the proposal at these hearings. After the current public comment period ends and the state submits its waiver proposal to CMS, there will be another public comment period.

In advance of that submission, advocates from the Disability Advocates Advancing our Healthcare Rights (DAAHR) coalition traveled to Washington, D.C. to meet with Congressional offices and with CMS representatives to share their perspective on the waiver proposal. Pictured are (front left to right) Renée Markus Hodin, Deputy Director of the Center for Consumer Engagement in Health Innovation, DAAHR advocates Bill Henning, Executive Director of the Boston Center for Independent Living, and Dennis Heaphy, Policy Analyst, Disability Policy Consortium, and Carol Regan, Senior Advisor with the Center.

In other news, Health Care for All hosted the fourth annual Patient and Family Advisory Council (PFAC) Conference bringing together PFAC members, advocates, researchers and providers. The day-long event included sessions focused on meaningful engagement on PFACs, how PFACs can be involved in Community Benefits, research and quality measurement efforts, building the case for PFACs and developing a strategic plan for PFACs.


The June enrollment numbers for the MI Health Link program, the state’s dual eligible demonstration project, have been posted on the state’s website.


The Department of Health and Human Services and the Office of the Assistant Secretary for Planning and Evaluation (ASPE) released an evaluation report on the Minnesota Senior Health Care Options (MSHO) program for Medicare-Medicaid enrollees. The report, developed by RTI International, evaluates MSHO’s outcomes from 2010 to 2012. The data indicates that outcomes are better for Medicare-Medicaid eligible individuals enrolled in integrated managed care than those enrolled in traditional Medicare and Medicaid programs. The findings show that managed care plans had greater primary care physician use and lower inpatient hospital and emergency department use. The report found that MSHO enrollees were: 48 percent less likely to have a hospital stay and those who were hospitalized had 26 percent shorter stays. MSHO enrollees were also 13 percent more likely to receive home and community-based long term care services. Once enrolled in the fully integrated plan, nearly all beneficiaries chose to remain.

New Jersey

On June 15 the New Jersey Department of Human Services, Division of Medical Assistance and Health Services (DMAHS) presented its plans to strengthen the state’s Medicaid program under an 1115 waiver renewal with alignment and redesign through care integration. The state is seeking to:

  • Maintain its Managed Long-term Services and Supports (MLTSS) program;
  • Move to an integrated and managed behavioral health delivery system that includes a flexible and comprehensive substance use disorder (SUD) benefit;
  • Increase access to services and supports for individuals with intellectual and developmental disabilities;
  • Further streamline NJ FamilyCare eligibility and enrollment;
  • Increase care coordination options for individuals who are dually eligible;
  • Develop an uninterrupted reentry system for incarcerated individuals;
  • Target housing support services for individuals who are homeless or at risk of being homeless;
  • Expand and enhance current value-based purchasing strategies;
  • Enhance access to critical providers and underserved areas through alternative provider development initiatives;
  • Continue DSRIP funding to promote and foster health care delivery system innovations; and
  • Expand and enhance population health partnerships with community and faith-based organizations, public health organizations, health care providers, employers and other stakeholders to improve health outcomes for Medicaid-eligible individuals.

New York

The New York Department of Health has released its transition plan to eliminate the 1915(c) Home and Community-Based Waiver for the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) programs. The plan provides a roadmap for transitioning Medicaid recipients in these two programs into managed care. The current target date for the transition to begin is Jan. 1, 2018. The 30-day comment period on the plan is expected to begin on July 15, 2016.

The United Hospital Fund is holding its annual Medicaid conference entitled Medicaid in New York:  Progression to Value-Based Payment. The conference is on July 14 at the New York Academy of Medicine.


The Oregon Health Authority released its fourth annual Coordinated Care Organization (CCO) Metrics Report, which details CCO performance on a variety of quality measures and the incentive payments health plans receive based on their results. For 2015, Oregon CCOs received a combined total of $168 million in incentive payments. These pay-for-performance funds mark a continued movement toward paying for quality and access to care – not just services delivered – in Oregon’s health care system. Report highlights include findings showing: decreased hospital readmissions; decreased hospital admissions for short-term complications from diabetes, chronic obstructive pulmonary disease, congestive heart failure and asthma; increased access to primary care for children and adolescents; increased rates of dental sealant use; increased use of contraceptives; increased blood sugar testing for adults with diabetes; increased enrollment in patient-centered primary care; and increased CCO member satisfaction.

Rhode Island

Rhode Island’s Aging in Community Subcommittee of the Long-Term Care Coordinating Council released a report which examines the state of affairs for aging Rhode Islanders. The report provides demographic data on the state’s older population, inventories current services and resources, identifies challenges faced by seniors and recommends strategies to promote successful aging in community in nine issue areas: Information and Communication, Community Engagement, Transportation, Economic Security, Food Security and Nutrition, Housing, Supports at Home, Healthcare Access and Open Spaces/Public Buildings.

Also, the Medicare-Medicaid Coordination Office (MMCO) posted a Provider Frequently Asked Questions (FAQs) document for the Rhode Island Integrated Care Initiative dual eligible demonstration project.