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Step 2 in New Hampshire’s Medicaid managed care implementation postponed

Posted: October 3, 2014

Step 2 in New Hampshire’s Medicaid managed care implementation postponed

By CASEY McDERMOTT

Monitor staff

Friday, October 3, 2014
(Published in print: Friday, October 3, 2014)
New Hampshire officials have again decided to push back the second phase of managed care for the state’s Medicaid program – which was going to begin Jan. 1 – in part because of concerns raised about its potential impact on those receiving intensive or complex medical care, and in part to allow more time to prepare for its eventual implementation.

Department of Health and Human Services Commissioner Nick Toumpas announced the change in plans at yesterday’s meeting of the Governor’s Commission on Medicaid Care Management. Toumpas had stressed at earlier meetings that the initial timeline would be changed if necessary.

A new timeline will be presented at the commission’s next meeting, scheduled for Nov. 6 at the Gorham Town Hall Auditorium, Toumpas said.

Under the state’s Medicaid Care Management program, New Hampshire has contracted with companies – Well Sense and New Hampshire Healthy Families – to oversee the coordination of health care for its Medicaid population. The department says the changes are meant to take a more holistic approach to health and improve quality, but also to bring more financial stability to the program, which has for years operated under a fee-for-service model.

Earlier this summer, the state unveiled a timeline that would have required many Medicaid recipients who rely on long-term care and supports – people who have developmental disabilities or live in nursing homes, for example – to enroll in managed care plans at the beginning of 2015. Even earlier, the state signaled plans to start that transition Dec. 1, but officials decided to delay it in April.

The “Step 2” of managed care implementation, as presented this summer, would have been broken up into three phases beginning in January. The long-term care population was allowed to opt-out of the state’s managed care programs during “Step 1” of the program, which took effect this year, but are required to enroll under the next step.

The original Step 2 schedule worried families and advocates who, at a series of forums in recent months, said they were troubled by the state’s plans to move forward with the next phase of managed care when many issues seen in the first phase were still unresolved. As described by families and acknowledged by the department, these issues have included the managed care plans’ denials of certain treatments and prescriptions, as well as other challenges.

News of the delay was met with applause at yesterday’s commission meeting – where the crowd included medical industry professionals, lawyers and advocates, individuals who have transitioned under Step 1 and others who are set to transition under Step 2.

Still, some said the announcement did not entirely ease their concerns.

“I’m elated, but I still think when it does roll out, we’re still going to be looking at some systemwide issues,” said Denise Colby, a member of Advocates Building Lasting Equality in New Hampshire.

Colby’s son has autism, and she said he transitioned to managed care last December. The delays in service authorizations she has experienced with her son’s Well Sense plan have been challenging, to say the least.

Colby is one of hundreds of people who have attended commission meetings and public forums in recent months to speak out on the changes. Their active involvement – and state officials’ willingness to listen to them – has been critical, said managed care commission member and Crotched Mountain Rehabilitation Center President Don Shumway.

“The department’s work is done best when everyone participates in it and everyone owns it,” said Shumway, who also has served as commissioner of the Department of Health and Human Services. “That’s what you’re seeing, and that is what Governor Hassan did to assure when she created the commission, to assure that participation.”

Hassan’s spokesman, William Hinkle, said in an email that “getting implementation right and addressing the public’s concerns have always been the most important thing throughout the Step 2 process.”

“Governor Hassan has consistently said that Step 2 would not be launched until it was ready,” Hinkle said, “and there is critical work left to do to ensure that Medicaid recipients continue to receive the best possible community-based care in a managed care environment.”

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