Massachusetts on Thursday became the first state to sign on to a program that will change the way it pays for the complex and costly health care of up to 110,000 adults with disabilities.
At least 25 other states are considering the program, created under the federal Affordable Care Act. But disability advocates and policy analysts have expressed concern that the program is being rolled out too quickly.
The program affects people aged 21 to 64 who are eligible for both Medicare and Medicaid, often referred to as “dual eligibles.” The parallel plans can be confusing for patients and hinder communication between doctors and hospitals. The new program will enroll those patients with state-contracted insurers that will oversee all of a patient’s medical, mental health, and long-term care benefits.
The agreement between the Patrick administration and the US Centers for Medicare & Medicaid Services formalizes plans state officials have been working on for more than a year. This summer, the state began taking applications from insurers interested in becoming “integrated care organizations.” The successful bidders are expected to be announced next month.
Unless they choose to opt out, dually eligible people will be enrolled in one of the organizations serving their county. Coverage is expected to begin next April and result in up to 2 percent savings for the state and federal programs.
“By entering this agreement with the Obama administration, we continue to be a leader in providing integrated, high quality care for our residents with complex needs,” Governor Deval Patrick said in a statement.
Nationally, the program has faced scrutiny. The Medicare Payment Advisory Commission, an independent agency created by Congress to evaluate changes to Medicare, said in a letter to federal officials last month that it supports the overall goal but worries the program is being implemented too widely.
If all 26 states pursue plans for the program, about 3 million people would be enrolled, the letter said. Rolling back such a large program if it fails to improve care or save money would be tricky, the letter said.
“This is, after all, an experiment,” said Al Norman, executive director of Mass Home Care, a network of nonprofits that provide home-based care. “We’re going into this with some trepidation about how it’s going to work out.”
His parent organization, the National Association of Area Agencies on Aging, joined other consumer groups in writing to the Centers for Medicare & Medicaid Services with recommendations, including slowing implementation. The American Medical Association also asked for delay of a year or more.
The Centers for Medicare & Medicaid Services is taking those concerns into consideration, said spokeswoman Courtney Jenkins.
In Massachusetts, leaders of the largest industry groups representing hospitals, doctors, and behavioral health systems are concerned that integrated care organizations picked by the state will use their market power to negotiate rates lower than what Medicare pays hospitals and doctors today.
“This program is new and will need robust participation from providers in order to be successful,” they wrote in a letter to Massachusetts Secretary of Health and Human Services Dr. JudyAnn Bigby. “Cutting payment rates will have the opposite effect.”
Bigby said in an interview that while rates will be set by negotiation, the state has told the integrated care organizations that it expects providers to be paid Medicare rates for services now covered under that program.
Blue Cross Blue Shield of Massachusetts, with the Massachusetts Behavioral Health Partnership, has applied to serve enrollees in 11 counties. Audrey Shelto, a Blue Cross senior vice president, said the program is on “an aggressive time frame.”
“The urgency comes from the widespread recognition that the current system really isn’t working for anyone,” she said. “Our approach is that we’re going to move very thoughtfully and very careful.”
Bigby said that dually eligible seniors have told her they feel the care they get now is inadequate. The state plans to monitor the integrated care organization, focusing on access to and quality of medical and mental health services.
Bigby noted that Massachusetts pioneered a program to manage the health benefits for 25,000 dually eligible seniors, who are low-income and over 65. That program, while smaller and developed over eight years, is widely considered a success.