Reform Update: Public health organizations work to prepare providers for Medicaid expansion

Three leading public health organizations have announced plans to partner in a project aimed at helping the nation's healthcare providers prepare for the 2014 expansion of Medicaid coverage (PDF) under the Patient Protection and Affordable Care Act.

America's Essential Hospitals, the National Association of Community Health Centers and The George Washington University School of Public Health Services have joined in a three-year, $1.8 million collaboration funded by Kaiser Permanente to assess areas where hospitals, clinics and other health providers can partner to meet the challenges expected to arise as a result of millions of Americans becoming newly eligible for Medicaid.

“It's really significant that we're getting together now in a very formal way around people we care for,” said AEH President and CEO Bruce Siegel. “It will send a message that health centers and safety net hospitals are now working together.”

Siegel said the goal of the initiative was to lay the groundwork for the creation of a partnership model that healthcare providers throughout the country can view as a framework to building their own collaborations.

The partnership will identify five states or regions in greatest need of targeted assistance to create a stakeholder support network as a model for other areas. The project will assess safety net providers' preparedness for the expected influx of newly insured patients; provide evidence-based tools, reports and technical assistance to communities to help build capacity; and evaluate progress toward improvements in coverage, care coordination, and patient experience.

A key project goal will be to identify safety net collaborations that successfully integrate care to ensure seamless transitions from enrollment to participation in medical homes and referrals to other safety net providers. The project will help safety net providers build capacity to guide uninsured people, especially complex patients discharged back into medically underserved communities, through the healthcare system.

In states still undecided about expanded Medicaid coverage under the ACA, the project will seek to educate decisionmakers about how coverage decisions will affect their communities.

A decision on exactly which states or regions will be targeted for assistance is expected by Aug. 31. According to AEH spokesman Carl Graziano, the criteria for selection will be based on a number of factors, including the status of state exchanges and Medicaid expansion as well as the number of uninsured affected in each potential state.

A plan to insure disabled adults younger than 65 in Massachusetts who are dually eligible for Medicare and Medicaid has been scaled back due to an unwillingness by some insurers to participate in the program.

The Boston Globe reported half of the insurers who had said they would participate have opted out of the voluntary One Care program, which was intended to manage care for the state's low-income and disabled people ages 21 to 64 whose healthcare bills are covered by Medicare and Medicaid.

Three insurers, including Boston Medical Center HealthNet Plan, Neighborhood Health Plan and the state's largest insurer, Blue Cross and Blue Shield of Massachusetts, will not participate in the program. They cited expected losses from participating in the program.

Three in four low-income seniors suffering from a chronic illness say they found it difficult to manage their health because of factors such as money or a lack of energy, according to a survey conducted by the National Council on Aging, UnitedHealthcare and USA Today. That's compared with 53% of seniors overall who say the same, according to the survey.

Low-income seniors are likely to be dual-eligibles receiving both Medicare and Medicaid coverage.

While the survey found 86% of seniors were confident they would be able to maintain a high quality of life throughout their senior years and 60% expected their health to stay about the same during the next five to 10 years, 51% had not set in place goals in the past year toward managing their health.

Follow Steven Ross Johnson on Twitter: @MHSjohnson