Alabama wants to delay plans to move its Medicaid program to a managed-care model with regional care organizations. State officials say financial issues might make it tough to implement a program that was aimed at lowering healthcare costs and improving patient care.
Last year, the CMS approved an 1115 waiver that provided up to $748 million over five years to move Alabama away from traditional fee-for-service healthcare delivery. Even with the federal dollars, the state told the CMS it does not have money to help providers switch to RCOs in a notice posted by the agency Monday.
Alabama officials already have delayed their original start date of April 2016 for the program. The original end date was March 2021. Now state officials want a new agreement that starts this April 1 with an end date of March 31, 2022.
The state is also looking to postpone the actual launch of the RCOs by a year until Oct. 1, 2017.
Alabama's Medicaid Commissioner Stephanie Aza said the state is looking to appropriate more funds but did not say how they would go about it.
Gov. Robert Bentley, a licensed doctor and a Republican, last year said he was committed to moving forward with the switch to managed care. He admitted then there were a few unknowns, including state funding and whether the Trump administration will give states block grants allowing more flexibility to write the rules for their programs.
Alabama passed legislation in 2013 to implement RCOs, its version of accountable care organizations. The groups would be managed by local providers, which would deliver healthcare services to Medicaid beneficiaries at a fixed cost.
More than 650,000 of Alabama's 1 million Medicaid recipients will receive their care through an RCO. The elderly, persons with disabilities, pregnant women, children under 19 and caretakers will receive benefits.
Under state law, the RCOs are divided into five regions of Alabama. Eleven local providers have been approved by the state so far to participate, with at least two providers per region. The participants include community hospitals and clinics that will provide primary and specialty care, as well as behavioral health services. They include Centene, Triton, St. Vincent's Health System and Jackson Hospital.
