Some providers say a proposal to transform Washington state's Medicaid program doesn't take into account the needs of children and could dissuade their colleagues from treating beneficiaries in the program.
The state is seeking $3 billion in federal funds (PDF) to overhaul its Medicaid program via a five-year pilot project.
It seeks to have its managed Medicaid plans oversee both mental and physical health services, as the two are now largely addressed separately, and Washington also wants to change the way it pays for care.
By 2019, the state aims for 80% of its Medicaid care to be purchased through value-based payment.
The state also wants to launch a Delivery System Reform Incentive Payment (DSRIP) program, which allows federal Medicaid funding to to finance incentives for providers to pursue delivery-system reforms.
DSRIP involves infrastructure development, system redesign and clinical-outcome and population-focused improvements.
It would first focus on meeting metrics to successfully set up the reforms.
Later, the focus would shift to outcomes-based metrics such as population health improvements.
California, Kansas, New Jersey, New York and Texas also have DSRIP initiatives taking place in their states.
Washington health officials say the waiver is needed because of the Medicaid population explosion prompted by the Affordable Care Act.
Medicaid beneficiaries have grown 45% from 2013 to 1.8 million people today, said Nathan Johnson, chief policy officer of the state's Health Care Authority.
“This waiver is about building a more sustainable Medicaid program,” Johnson said.
State officials are mindful they'll be on the hook for millions once federal funding to encourage expansion drops.
The federal government is picking up 100% of the cost through the end of 2016 and it gradually decreases to 90% by 2020.
“The concern is that Medicaid doesn't pay much to begin with, and we want to make sure we at least maintain the base payments we have now,” said Preston Simmons, CEO of Providence Health & Services Northwest Washington region.
Providers say the Washington waiver doesn't outline how exactly it will reach all of its goals. They want to be sure they get reimbursed for money they'll spend to implement systems outlined in the waiver, Simmons added.
Physicians are especially worried about the state's ambitious 80% value-based purchasing goal.
“There's a little bit of apprehension as we don't know what that means,” said Jennifer Hanscom, CEO of the Washington State Medical Association. “We want specifics.”
Others expressed concern that the waiver appears to have no initiatives that explicitly target children, who make up 45% of the state's Medicaid program, said Dr. Mike Dudas, president of the Washington Chapter of the American Academy of Pediatrics and chief of pediatrics at Virginia Mason Hospital & Medical Center in Seattle.
“Given it's such a large population of Medicaid that's already facing significant gaps in care, this waiver could pose a significant opportunity to change things,” Dudas said.
The federal public comment period on the waiver opened Sept. 10 and will last through Oct. 9, 2015.