A consultant firm hired by Arkansas legislators is recommending the state consider continuing its Medicaid expansion program – in some form - with adjustments. The private option, or Health Care Independence Program, would be retooled and branded as T-HIP, the Transitional Health Independence Program.
The Stephens Group report released Wednesday also calls for reforms to the larger Medicaid system, including: a shift to managed care, cost-sharing based on meeting wellness requirements, and work referrals. An emphasis on outcome based payments supported by Patient Centered Medical Homes and episode of care models of pay, rather than fee for service, was at the center of testimony from the reports authors.
John Stephen, head of the New Hampshire-based group, spoke to members of the Health Care Task Force and said Arkansas can both better serve and reap savings by addressing high cost populations in traditional Medicaid related to age, disability, and mental health.
“There’s an overly high utilization of nursing home and other institutional settings and there are barriers to community based care that are not existing in other states that we have learned during the way. We’ve identified some of them for you in the recommendations,” said Stephen.
Improving verification and eligibility checks for Medicaid was identified as a serious problem but one that should be viewed as fixable to Stephen. He said it’s a costly problem with over 40,000 traditional Medicaid and private option beneficiaries possibly living out of state.
“Risk indicators that were found absolutely convince us that you have a problem that needs to be addressed. There are folks that are out of state, in our opinion based on the data, that could have legitimately moved out of state but our not telling the department and you’re paying…every month to a carrier because you’re not checking routinely if someone’s moved,” said Stephen after cautioning there is not substantial evidence of fraud.
The recommendations also call for expanding dental and vision coverage and non-emergency transportation. The benefits could be offered as incentives to those meeting wellness benchmarks and also result in cost savings according to the report. Those benefits were targeted by conservatives in the state Legislature and have been eliminated since Medicaid expansion launched.
Task force chair state Representative Charlie Collins (R-Fayetteville) characterized the report’s release as the beginning of a phase in which legislators will coalesce, or not, around specific recommendations. The task force, created by the Legislature earlier this year as part of a deal to continue the private option through 2016, is expected to release a set of recommendations in late December.