The HUSKY insurance program won’t be moving out of managed care just yet, but changes could still be coming.
Legislators earlier this year authorized the state to change the way the HUSKY and Charter Oak health plans are managed, a move anticipated to save $76 million this fiscal year.
But on Friday, the Medicaid Care Management Oversight Council’s executive committee recommended taking a step back to review multiple options for changes to HUSKY and other Medicaid programs.
The decision stems from concerns by council members that they did not have enough information about patient care and outcomes to determine the best way to restructure the program. Since the change has not yet been made, State Sen. Toni Harp, the council co-chairwoman, said it is unlikely that the $76 million savings can be achieved this fiscal year. Some council members also said the impending turnover in the governor’s office will make it difficult to make a major change to HUSKY now.
Harp said the Connecticut Health Foundation will offer technical help in reviewing different models for managing the HUSKY program, which covers nearly 400,000 children and parents, and for other Medicaid programs. The foundation will examine models that move the program out of managed care, a managed care option, a plan that would eliminate insurance companies entirely, and other options.
“We hope that they will be able to help us with that by sometime in November,” she told the council.
HUSKY has been under managed care for more than a decade. The state pays insurers a set amount of money per month for each client, and the insurers use that money to pay medical claims. Patient advocates have argued that the model gives insurers a financial incentive to deny care.
Earlier this year, Gov. M. Jodi Rell proposed moving HUSKY and Charter Oak to a different system, in which the state is responsible for paying medical claims and insurers are paid a lower fee to administer the programs. The law that ultimately took effect did not require the change, although the $76 million in savings was figured into the budget.
But Department of Social Services officials raised concerns about the proposed new model, which calls for using the insurers’ networks of health care providers, and the rates they negotiate, but having the state pay the bills. Commissioner Michael Starkowski said that would be problematic since insurers would have no incentive to negotiate cost-effective rates.
In a presentation to the council last month, the department described three options for restructuring HUSKY.
Two involve making the state responsible for paying medical claims and paying insurers a lower fee to administer the plans, as the legislature authorized.
But under one option, the program would use the insurers’ networks of health care providers and pay the rates the insurers negotiate. Under the other option, HUSKY would use the state’s fee-for-service network and rates for providers, which is currently a smaller network.
The third option would maintain managed care but put limits on the level of profits and losses the insurers can have.
Patient advocates have urged the adoption of another model, called primary care case management. Under that model, which is in limited use in HUSKY, health care providers coordinate patients’ care and receive a per-patient fee to do so. It would eliminate the role of insurers.
Mark Schaefer, DSS’ director of medical care administration, told council members that the department believed the federal Centers for Medicare and Medicaid Services favored keeping a capitated system.
But in a telephone conversation with the Medicaid oversight council’s executive committee earlier this month, CMS officials said they were not trying to steer people toward managed care. Instead, they said, they would work with the state to implement a program that met its goals.
That prompted members of the executive committee to discuss their goals for the program. Several said it would be difficult to determine the best model for managing the program without knowing the quality of care or health of clients in the existing system.
The Connecticut Health Foundation will review the three models DSS suggested, primary care case management, and other models, Harp said Friday.