Maryland has delayed until Feb. 1 the start of a plan to enroll Medi-caid beneficiaries in managed-care plans, giving provider-sponsored managed-care organizations an additional month to decide whether to jump into the program.
The state General Assembly passed enabling legislation in April, and state health officials had been pushing to meet a Jan. 1 start-up date. But HCFA didn't clear the program for takeoff until late October, and an actuarial analysis of program costs that form the basis of computing capitation rates was completed just two weeks ago.
Healthcare and consumer interests, including the Maryland Hospital Association, had criticized the ambitious timetable as inadequate for public education and provider preparation.
The extra 30 days will give providers some breathing room to prepare for substantial changes in caring for the Medicaid population, although it still may not be enough time to draw up business plans and make contracting decisions, said Nancy Fiedler, spokeswoman for the MHA.
But the state budget already assumes the program's prevention-oriented focus will save $19 million by June 30, and Fiedler said the hospital association realizes that the state health department can't delay the start any further and still hit that target.
The program's aim is to enroll about 75% of the state's 440,000 Medicaid beneficiaries into managed-care plans. About 25% already are voluntarily enrolled, and another 50% participate in a state-operated fee-for-service system that includes case management.
State legislation also paved the way for provider-sponsored managed-care organizations to contract directly with the Medicaid program instead of through insurers, but those provider entities are still evolving, Fiedler said.
To date, only the Johns Hopkins Health System has declared it will compete for Medicaid business when the program takes effect, she said. Four or five other proposed groups are considering the idea.