Connecticut’s Medicaid efficiency is at the providers’ expense

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Here’s insight into the recently released Report: Medicaid-expansion states, led by CT, reduce per-person costs which ran in The Mirror.

If Connecticut residents are wondering what Connecticut’s “secret sauce” is to rank us tops in efficient Medicaid spending, it’s a combination of:

  • Inadequate and flat Medicaid reimbursement to home health providers (There has been no rate increase for 10 years.)
  • A State Plan Amendment (which we fought bitterly last year) cutting Medicaid behavioral home health nursing rates by 15 percent.
  • A State Plan Amendment (just announced this month) to eliminate the “add-on” Medicaid payments to home health agencies who serve the four most vulnerable Medicaid client categories (AIDs, maternal child health, inner city clients where home health workers need “escorts” to safely work in certain neighborhoods, and pediatric extended care.)
  • A very aggressive state audit department that deploys extrapolation to claims processing to recoup dollars from Medicaid providers years after legitimate and approved services have been provided.

Connecticut’s top ratings are at the suffering and demise of our Medicaid provider community.

Connecticut is a very challenging state for home health agencies to do business, despite being the most cost-efficient and patient-preferred means of delivering care. Several agencies have opted out as Medicaid providers this year and others are beginning to discharge clients (appropriately) and not accept new ones.

The perfect storm has been brewing and I expect that Connecticut’s standing in this report will drop sharply in the next few years as Medicaid clients will rebound back to more costly institutional care.  While home health care’s value proposition is clear, our state budget deficit is so severe that shortsighted decisions have shredded our Medicaid safety net.  This is a very critical issue for home health providers and others across the continuum.

The glowing headline unfortunately doesn’t reveal the reality of our Medicaid healthcare delivery system in our state.

Deborah Hoyt is President and CEO of  the Connecticut  Association for Healthcare at Home.

What do you think?

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