On Friday the state filed its 3-year Medicaid waiver extension request with federal CMS officials. The Medicaid waiver allows the state to receive federal funds for both the mid-90s MassHealth expansions and the new health reform programs under chapter 58. The current waiver ends on 7/1/08, and negotiations start now over the terms of the extension.
The waiver request (click here to read) is a good summary of all the achievements of health reform to date. In her cover letter, Secretary Bigby emphasizes the need for continued federal support:
“Health care reform implementation, however, is still in its infancy. The next three years of the Demonstration’s operation will be critical to ensuring continued growth in MassHealth and Commonwealth Care enrollment, reducing utilization of the state’s free care pool, and increasing transparency and accountability around health care quality and costs. The Commonwealth always envisioned that implementing health care reform would take several years, and the plan’s success is dependent upon the continued support and commitment of all stakeholders in the effort.”
However, the waiver documents do not include much financial information, including how the state plans to meet the budget neutrality requirements. Secretary Bigby explains that financial details on the Commonwealth Care program, Safety Net Care Pool and other programs will not be available until the fall of 2007.
News: Pool Use Down Substantially
The waiver request includes new statistics showing a substantial drop in Pool utilization (PFY is the “Pool Fiscal Year,” which start in October):
The waiver request reports that “As health insurance coverage has expanded dramatically, the number of uninsured individuals determined eligible to receive services paid for by the state’s uncompensated care pool has decreased by 35% from October 2006, when the state implemented Commonwealth Care, through March 2007. Uncompensated Care Pool utilization has decreased by almost 13 percent during this same period, demonstrating that the success-based model originally envisioned is working.”
This is a major impact that both federal and state officials will be pleased to see. It shows that the expansions in MassHealth and the creation of Commonwealth Care have reduced the ranks of the uninsured who were relegated to the Pool. We understand the impact of health reform on Pool use so far has been uneven, with some hospitals reporting major declines, and others not experiencing major changes. The key statistic – not reported above – will be if there has been a decline in Pool costs. For health reform to work financially, a portion of the Commonwealth Care costs must be balanced with Pool savings.
For the wonky readers, the Pool submission also included 4 attachments: the Connector press release trumpeting their marketing campaign with the Red Sox, the Quality and Cost Council’s new goals, and two mark-up versions of current waiver attachments showing requested changes: one dealing with MassHealth eligibility, and one on IP and Family Assistance Premium Assistance.
