Some providers say a proposal to transform Washington state's Medicaid program doesn't take into account the needs of children.
The state is seeking $3 billion in federal funds to overhaul its Medicaid program in 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.
The state also wants to change the way it pays for care. By 2019, it aims for 80% of its Medicaid care to be purchased through value-based payment. It also wants to launch a Delivery System Reform Incentive Payment program, which allows federal Medicaid funding to finance incentives for providers to pursue delivery-system reforms.
Providers say the waiver proposal doesn't outline how exactly it will reach all of its goals. 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.
“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,” said Dr. Mike Dudas, president of the Washington chapter of the American Academy of Pediatrics.