Under a nearly approved waiver, the state of Washington will focus on the social needs of its Medicaid population and leverage partnerships between providers and social support groups in an attempt to improve patients' quality of care.
The CMS has granted Washington preliminary approval to overhaul its Medicaid program (PDF). As part of the five-year waiver, for which the state will receive $1.5 billion in federal funds, the state will launch delivery-system reform initiatives and expand options for long-term services and supports.
The approval is expected to be finalized in the next few weeks once the state and the CMS hash out special terms and conditions.
State officials sought out the waiver as a way to help address Washington's ballooning Medicaid population, which jumped nearly 60% since 2013 to 1.7 million enrollees according to federal data. Medicaid spending jumped from around $7.8 billion to $10.4 billion during the same period.
The waiver allows for three major changes: the first is creating accountable communities of health to operate across the state. Each region will find new ways to craft delivery system reforms that take into account social conditions that can affect health. The idea stems from the CMS Innovation Center and reflects the government's goal to shift from fee-for-service to value-based care.
The model aims to address issues such as housing instability and quality, food insecurity, utilities and transportation. Federal law prohibits Medicaid from paying for housing outright, so the state program will instead help people find appropriate housing and provide tenant support. The state would also offer job coaching and training.
Accountable communities of health and their provider partners can receive bonuses for meeting certain benchmarks. The community health models also will team up with managed-care plans in the state to move 90% of Medicaid payments to a value-based model by 2021.
Dr. Shane Macaulay, president of the Washington State Medical Association, said the waiver will give doctors the financial support to adapt to a value-based system.
California, Kansas, New Jersey, New York and Texas have similar initiatives in place.
Health plans in Washington state opposed the initial proposal, saying it could lead to member confusion and reduced transparency.
Daryl Edmonds, president of Amerigroup Washington, expressed cautious approval to the state policy website State of Reform. It will be important for those designing the programs to determine what health and cost outcomes are desired before creating strategies, he said.
The waiver would also allow for training of unpaid family caregivers, as well as support for housework, errands and home-delivered meals.
“It opens the door for more innovation and positive impact with our Medicaid program,” said Bob Marsalli, CEO of the Washington Association of Community and Migrant Health Centers.