As one New England state gears up to revamp its Medicaid program through the use of accountable care organizations, another will receive federal funds to pilot its own Medicaid overhaul.
Both developments come amid news that President-elect Donald Trump will nominate consultant Seema Verma—who helped engineer Indiana’s unique Medicaid expansion—as the head of the Centers for Medicare & Medicaid Services. Verma is expected to advocate for similar policies in other states.
In Massachusetts, six healthcare provider networks are poised to launch pilot programs under which they will get a set budget to care for about 160,000 residents enrolled in the state’s version of Medicaid, MassHealth, the Boston Globe reports. To do so, the provider networks will form ACOs that will share in potential savings as well as take on financial risk.
CMS approved the state’s request for a five-year Medicaid waiver earlier this month, authorizing it to spend $52.4 billion in federal funds. Massachusetts health officials previously told the Globe that they hope the new ACO arrangement will help control MassHealth costs, which have consumed nearly 40 percent of the state’s budget.
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Meanwhile, in Rhode Island, officials announced that CMS approved it to spend $129 million in federal funds over five years to revamp its Medicaid program and boost healthcare workforce training.
The effort, dubbed “Reinventing Medicaid 2.0 - Health System Transformation,” will aim to boost care coordination through the use of managed care organizations and provider partnerships, with the goal of reducing expensive hospital visits and procedures. It will also invest in strategic partnerships between the state’s public higher education institutions and healthcare providers to train future healthcare workers.
"These federal funds will help us continue to shift our publicly financed healthcare system toward alternative payment models that ensure we're paying for value, rather than volume of services,” Rhode Island Health & Human Services Secretary Elizabeth Roberts said in the announcement.