Managed Care and Indiana Medicaid – A Summary from the 2013 Legislative Session

Though the utilization of managed care for Medicaid programs is certainly not new across the country, or in Indiana, IHCA did not expect to be dealing with a specific effort to include the Medicaid Aged, Blind and Disabled population (ABD) into managed care during this session of the Indiana General Assembly.  The first sign of an effort to require enrollment of the Medicaid ABD population into managed care was seen in an amendment to HB 1591, authored by the House Public Health Committee Chairman, Rep. Ed Clere (R-New Albany).  The language would have required the state to apply for a waiver to move the Medicaid ABD population into risk based managed care by October 1, 2013.  Oddly, the language also called for state to study such a program at the same time it was supposed to design and submit a plan to actually implement a program  IHCA testified and shared its concerns about including long term care into any ABD managed care program, and especially doing so without considering key factors such as the potential impact on resident services, access to care, provider networks, the Quality Assessment Fee, and the IGT/UPL program with county hospitals, as well as the expedited timeframe that was essentially impossible to meet. 

While the language in HB 1591 did not continue on in the process, the very next week the Chairman of the House Ways and Means Committee, Rep. Tim Brown, M.D. (R-Crawfordsville) inserted language in the House Budget Bill that would have required the state to study the issue and move the ABD population to risk based managed care by July 1, 2014.  IHCA met with Rep. Brown and expressed our concerns with the approach and implementation timeline.  The significant strategic concern was that managed care language was now in the House Budget Bill, which is a bill that must be passed and does not die.  This meant that the debate surrounding Medicaid ABD managed care was not going to go away.

A more reasonable approach to this issue was started in Senate Bill 551, authored by Sen. Patricia Miller (R-Indianapolis), that would have required a general study of the issue without an implementation mandate or deadline.  Similar to the fate of the initial House bill (HB 1591), SB 551 did not move out of the House after having passed through the Senate.  However, during this time IHCA, along with other provider organizations, was able to convince the Senate to remove the ABD managed care language from the Budget Bill during the Senate’s consideration of that bill.  This was a significant undertaking, which was led by IHCA.  The association’s staff and lobbyists provided legislators and the Governor’s office with information about what other states are doing in this space, and that a rushed implementation was not the right way to go for patients or providers.

In the end, IHCA and several provider groups worked with all of the relevant authors, budget conferees, and FSSA to reach a compromise on a written report concerning Medicaid ABD managed care that must be completed by December 15, 2013.  The report must include careful consideration of what cost savings may be achieved, how a program would impact beneficiary choice of providers, how provider rates would be set, how care would be coordinated for dual-eligible patients, whether certain beneficiaries should be excluded from a managed care program, and whether a managed care program would affect the Quality Assessment Fee and Upper Payment Limit supplemental payments.  We believe that this will be a more productive process that will allow us to provide critical information about what Medicaid ABD managed care means for the long term care industry and ensure that all important factors are being taken into consideration before any implementation of a Medicaid ABD managed care program.