The Alabama Medicaid Agency should end its current fee-for-service model in favor of locally-led managed care networks that eventually can assume the responsibility and the risk for improving patients’ health outcomes, according to a report submitted to Governor Robert Bentley January 31 by the Alabama Medicaid Advisory Commission. Governor Bentley created the 33-member commission by executive order in October, tasking the group with evaluating the financial structure of the Alabama Medicaid Agency and identifying ways to increase efficiency while also helping ensure the long-term sustainability of the agency.
State Health Officer Dr. Don Williamson, who served as commission chair, emphasized that both patients and taxpayers will benefit from such a change. "For the patient, it could mean they are going to have more encompassing care. For the agency, this will be the biggest fundamental change in Medicaid since its inception," he said.
The commission’s recommendations included: 1) Alabama be divided into regions and that a community led network in each region coordinate the health care services of the Medicaid patients in that region; 2) Regional care networks formally engage consumer input and oversight at all levels of governance and operation; 3) The expanded regional patient care networks become risk-bearing organizations; 4) Regions may choose to contract with a commercial managed care organization to provide care, risk management, or other services in the region; 5) The Legislature where appropriate, and Medicaid where administratively possible, shall authorize regional care networks throughout the state and establish an implementation timeline. Specific benchmarks shall be set that must be met by the networks. Failure to meet the benchmarks shall authorize state intervention; 6) The Alabama Medicaid Agency should seek an 1115 waiver from CMS to implement the transformation to managed care; and 7) Legislation should be developed to create a Medicaid cap, provided that the legislation ensures adequate flexibility for the Alabama Medicaid Agency to address federal mandates, rules, and regulations; economic uncertainty; catastrophic health events; and provider rates.
Since the commission’s first meeting on November 1, 2012, members met several times to hear presentations from other state Medicaid programs, commercial managed care organizations and Alabama Medicaid’s Patient Care Networks, and to review cost and other data.
Commission members include health care providers, legislative leaders, state health and human service agency officials, consumers and insurers appointed by the Governor. Information on the Commission, including the final report, meeting minutes, presentations and membership, is available on the Medicaid website at: http://www.medicaid.alabama.gov/CONTENT/2.0_newsroom/2.2.1_Med_Adv_Commission.aspx.