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A bridge from now to 2014?

November 18, 2010

I was planning to report on this yesterday before we learned more about the medical errors at Women and Infants, but I ran out of time.   It’s still a relevant story, so I’m writing it up today-

Neighborhood Health Plan and The Rhode Island Community Health Center Association have been chatting about how to best take advantage of the health care overhaul’s expansion of Medicaid in 2014.

That’s the year all adults that make up to 133% of the poverty level (that equals $14,403 a year for an individual and $19,378 a year for a couple) will qualify for Medicaid.

Currently in RI, you can only get Medicaid if you’re low income and  pregnant, disabled, elderly, or a child/ parent.  There’s no option for poor people without kids.

In 2014, those folks will get health insurance too. The federal government will pay 100% of the cost of covering these new people until 2016. After that, states will gradually pay a portion of the cost. By 2020, they’ll be responsible for 10% of the bill.

But what do we do in the meantime?  The federal law allows states to start covering low income adults now, but we’d have to help pay for it.  That’s a tough sell in this economy.  So, Neighborhood Health Plan and The Community Health Center Association want to do something in between, that they *say* is budget neutral.

The proposal is called “Center Care”.  It would offer primary care, discounted prescriptions, mental health services, and family planning services to low income adults.  The idea is to get these folks into the system and meet their basic health care needs before the flood gates open on January 1st, 2014.  That way, folks can easily transition into full benefits and local community health centers can gradually gear up for a new set of patients.

Center Care advocates say about 35,800 Rhode Islanders currently qualify for these benefits, and they estimate they could recruit around 70% of them to join the primary care benefits program.

Great, but how could this possibly be budget neutral?  Neighborhood claims that federal matching funds would cover 5 million dollars of the 8 million dollar  price tag and the rest would be paid for by “offsetting outlays through medicaid program savings.”  The group is assuming the program would save 3.2 million medicaid dollars through “reduced maternity and delivery costs” among other cost savings because the new Center Care would reduce unwanted or unplanned pregnancies.

That’s quiet a stretch, but Neighborhood’s CEO Mark Reynolds says the estimates are based on the results of similar systems in other states like Maryland.  But, he acknowledges that it might be hard to believe.

“We expect there will be a reasonable amount of skepticism over any numbers, there should be… there is substantial experience though, that the provision of primary care and family planning benefits for a poor population can significantly reduce their health care utilization. And a significant part is reducing delivery costs which are substantial for this population.”

Elena Nicolella- the director of RI’s Medicaid program- says she needs a little more information about these cost and saving estimates before she’ll commit to the Center Care plan, but she says “it’s definitely worth taking a look at considering.”  Medicaid in the state might require some tweaking with RI’s budget crisis, but she says that doesn’t necessarily rule out this program, if an analysis really does show it could save the state money.

For Center Care to become a reality, the General Assembly would have to approve and apply for  an amendment to Rhode Island’s global medicaid waiver, allowing the state to use federal funds for the program.  Then the feds would have to approve the amendment.  Nicolella says the hardest part of that process would probably be getting the General Assembly’s approval.  The Feds are pretty excited about programs like this.  No legislator has volunteered to introduce legislation on Center Care yet.

The idea is early yet.  Reynolds says they still haven’t figured out if the program would have co-pays or premiums, although he guesses it won’t. He says he just wants people to start talking about the idea- it’s still open to changes and amendments.

What do you think of the plan?

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