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No States Opt for New Medicaid Health Home Program

Once effort gets going, reimbursement history may still diminish its appeal to physicians, ACP says

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An optional program encouraging states to coordinate and integrate care for Medicaid patients with chronic conditions has drawn no participants nearly five months after its implementation.

Duplication may have something to do with the slow start. "Many states have adopted medical home strategies in their Medicaid programs, but this particular option is new and we are currently working with states on implementing this new option," M. Gloria Sanchez-Contreras, a spokeswoman for the Centers for Medicare & Medicaid Services, said.

But, according to an American College of Physicians expert, poor reimbursement models for practitioners could limit physician participation, once the program gathers steam.

As part of the Affordable Care Act, states were offered a Medicaid Health Home option that became effective Jan. 1. With the promise of a federal match rate of 90 percent for the first two years, states can enroll Medicaid participants who have two or more chronic conditions, including serious mental health and substance abuse disorders, in a program that coordinates treatment of their conditions, called a health home.

The medical home concept has been around for more than 40 years. It initially referred to a central location for archiving children's medical records and later was expanded and modified into a concept aimed at providing accessible, comprehensive and coordinated care. The Medicaid version is consistent with the patient-centered medical home, an approach to providing comprehensive primary care to children and adults, that ACP has fostered for many years.

However, Medicaid's paltry reimbursement history may deter doctors from wanting to participate, said Neil Kirschner, ACP's senior associate for insurer and regulatory affairs.

Indeed, no states have approved participation plans yet, according to the U.S. Centers for Medicare and Medicaid Services.

"The way Medicaid pays right now, many of our members can't afford to participate," said Kirschner, noting that a provision in the health-reform law to bring Medicaid payments on par with Medicare in 2013 might boost interest later. "It's the type of thing we'd like to see, but right now it's a program that would not be a high priority to many of our members."

According to the Kaiser Family Foundation, Medicaid patients are eligible for the new health home program if they meet at least one of the following criteria:

  • They have at least two chronic conditions
  • They have one chronic condition and are at risk for another
  • They have one serious and persistent mental health condition
Under the Affordable Care Act, eligible chronic conditions are asthma, diabetes, heart disease, obesity, mental health conditions and substance abuse disorders.

States are allowed to provide the program based on all of the specified chronic conditions or to target certain populations in which the conditions are common. But if a state doesn't opt to target people with mental illness or substance abuse disorders, it must specify how it plans to meet people's behavioral health needs, according to CMS.

Three types of physician relationships can be used in the program:

  • Designated providers, meaning individual doctors, clinical practices, community mental health centers and other types of health organizations
  • A team of health professionals who work together and coordinate care with a patient's primary care physician
  • An interdisciplinary group of physicians and other health care professionals, which must include social workers and behavioral health specialists
Kirschner said that the new Medicaid health home program, despite its fiscal shortcomings, is designed to make health care "not just more affordable, but of higher quality."

"It's part of a general movement to provide more effective and integrated care," he said. "The requirements also recognize behavioral health, and that is notable."

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