State Medicaid plan reverts to fee for service

After more than a decade of operating under managed care, Connecticut's Medicaid program has gone back to a fee-for-service payment model, Stateline Health News reported. The reversion to fee for service began Jan. 1.

Altogether, Connecticut is directly reimbursing providers not only for Medicaid, but also Children's Health Insurance Program and other programs that insure low-income adults, for a total of about 600,000 lives, according to Stateline. The state is moving many patients into medical homes and beefing up its information technology infrastructure to adjust to the changes.

Moreover, Connecticut also is applying for a federal demonstration project to take better care of its dual eligibles--those who qualify for both Medicare and Medicaid, according to The Connecticut Mirror. The state spends about $3 billion a year on their care, even though they represent fewer than 10 percent of all Medicaid enrollees.

Patient advocates support the changes, particularly the move to fee for service, according to Stateline. They note that under managed care, most companies are interested primarily in their own bottom lines over the interest of their patients.

"I just don't understand why (other states) think it will work," Ellen Andrews, executive director of the Connecticut Health Policy Project, told Stateline.

However, the article noted that 70 percent of Medicaid beneficiaries in 2010 were enrolled through some form of managed care, according to data from the Centers for Medicare & Medicaid Services.

For more information:
- read the Stateline article
- here's the Connecticut Mirror article