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The Mystery of the Missing Accountable Care Dollars


Funding for Medicaid’s transition to accountable care is mysteriously missing from the Legislative Fiscal Analyst’s recommendations presented to the Social Services Appropriations Subcommittee this week. 
Why is the missing money so important?

  • The three Medicaid health plans (SelectHealth, Molina, + Healthy U) will be at “full risk” under accountable care.  That means the Department of Health will give them a set dollar amount each month to provide all the care that a person in their plan needs.  If a health plan can do that for less than that dollar amount, they keep the difference.  If they can’t, they take the loss.  This helps the state because it makes the Medicaid budget more predictable.  But it also means that a health plan could fail, potentially putting the well-being of their enrollees at risk.  As the health plans assume full risk, the Department needs to have the resources to watch their financial performance to identify issues before they become problems. 

The Governor’s budget recommends $309,000.

  • Under accountable care, the Department of Health will change the way it pays providers – moving from paying every time a service is provided to paying for making and keeping people well.  It will take the expertise of actuaries the Department does not have to do this right.  It will also take staff to track whether the health plans are meeting the goals the state sets for them and for the system as a whole.  That’s how we know if we are getting what we are paying for and how we will hold the health plans accountable. 

The Governor’s budget recommends $670,000.

  • As health plans take on full financial risk, they will still have costs under their old contracts with the Department of Health – costs the state is legally obligated to pay.  These costs are for health care services that were provided in the last months of the old contract but for which claims are filed after the contract ends. 

The Governor’s budget recommends $8.4 million.

Utah’s Department of Health spends only roughly 2% of the value of services on administration.  We have one of the leanest Medicaid administrations in the nation.  The next step for Utah is to invest in the transition to accountable care—a new system that pays providers to make people well.  The Governor’s budget recommendation for less than $1 million to strengthen Utah’s Medicaid administration is a critical investment in the success of accountable care.
 


Health Care Compact:  Utah, Beware of What You Ask For  

SB208 (Sen. S. Adams) would have Utah join the Health Care Compact, a coalition of states united around their commitment to ask Congress for an exemption from all PPACA (federal health reform) laws and regulations and for a block grant of all federal health care funds except veterans’ health care and the Indian Health Service.

Read more here.



Does SB111 Have a Chance?

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. 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.

Read more here





A Veritable Mosh Pit of New Bill Titles! 

February 2nd was the last day to approve bills for numbering without floor approval.  The result?   A veritable “mosh pit” of new health-related “boxcar” bills—that is, bills with titles only, no substance.  UHPP is in the process of investigating the 13 most disturbing titles of these empty (for now) bills.  Our biggest concern?  Hasty, piecemeal legislation that distracts our legislators from Utah’s own health system reform path. 

Read more
here



Announcements

New Tool: Programs for Refugee + Immigrant Families 

Utah Health Policy Project worked with the National Immigration Law Center to create this 
new tool showing exactly what federal programs immigrants (the 3 different main categories) are eligible for. Please distribute this widely so that we make sure refugee and immigrant families are getting into the right programs. This will help them take charge of their health and stay on the path to citizenship.

Utah's 2012 Legislative Session: January 23 - March 8, 2012

Visit the legislature’s website to see the legislative schedule, and find bills and representatives and senators.

Joint Utah Medicaid Partnership and Utahns For Sustainable Health Reform Meetings 

Join us at the Capitol for a joint UMP/U-SHARE meeting every Wednesday 1:15-2:00 in the 
Olmsted Room at the Capitol- Senate Building.

Getting to the Utah State Capitol

For maps, public transportation, and driving directions click here



HB144: Health System Reform Amendments, Rep. Dunnigan

This session’s main health system reform bill is now available to the public.  HB144, Health System Reform Amendments, sponsored by Rep. Jim Dunnigan, is “so far so good” and carries a $40K price tag. The majority of the expense in the bill will make it possible for the Health System Reform Task Force to meet on a day other than interim day in 2012—allowing for members to dedicate their full attention to the matters at hand instead of tacking the Task Force on to the end of a long interim day.  

Read more here





More Funding for Utah Children's Health Insurance? 

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! 

Read more here





The Division of Substance Abuse and Mental Health Requests Funds for Early Intervention Behavioral Health for Utah's Children

More than 20,000 of Utah’s children need, but don’t get, mental health services.  The Division of Substance Abuse and Mental Health (in the Department of Human Services) requested $3.5 million in new funding for early intervention in behavioral health this week.  Children with undiagnosed conditions are denied the freedom to learn in school and develop the full potential they will need as adult members of society. 

Read more
here




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