PCCM waiver hearing March 31st

Next Tuesday the Human Services and Appropriations Committees will hold a public hearing on DSS’ proposed waiver application to continue to run the HUSKY program. Click here for our comments. The notable part of DSS’ application is the decision to limit Primary Care Case Management (PCCM) to Waterbury and Willimantic and to only a select group of families and providers within those communities. PCCM is a way of running HUSKY without HMOs. In PCCM, consumers choose a primary care provider (PCP) who is responsible for providing their regular primary health care as well as coordinating any other care they need, for which they receive payment for services at feel-for-service rates and the massive sum of $7.50 per member per month to coordinate care. PCCM is working in 30 other states, improving health outcomes, keeping patients out of emergency rooms, attracting more providers to Medicaid, and saving states money. Often states have both PCCM and HMOs serving families in the same communities, offering options, providing competition that improves both programs, and keeping costs down. Last year, DSS granted our HUSKY HMOs a 24% rate increase. Not surprisingly, the HMOs have lobbied hard against PCCM.

DSS’ waiver application contradicts the PCCM plan submitted by DSS and approved by the two legislative committees in September without revision. That plan committed to providing PCCM statewide from the beginning anywhere providers showed interest in participating. The application also contradicts the department’s stated “intention” to expand PCCM to the entire state eventually. The legislator-approved plan was the product of a working group of advocates, providers and DSS staff that labored to develop the many details of the program. Advocates and provider representatives spent the summer crossing the state to recruit providers for PCCM. Hundreds of providers from across the state applied, despite a very tight time frame. However in January DSS made a sudden, unilateral decision to accept only 25 from Waterbury and Willimantic. Others have expressed interest since and have been denied, even from within Waterbury and Willimantic. Subsequently DSS crippled the program further by limiting enrollment to only a sample of current patients of those 25 providers. Not surprisingly, enrollment is miniscule – far too small to be economically sustainable. Can we expect that in a short time, DSS will announce that they tried PCCM, it didn’t work, and shut the program down forever? Maybe the HMOs didn’t have to try so hard to kill the PCCM bill two years ago.

On the bright side, the waiver application does acknowledge that PCCM will not cost any more than the HMOs. The CT Health Policy Project estimates that the state could reap significant savings with a legitimate PCCM program. At the very least, the HMOs would have trouble justifying 24% increases in a competitive environment. So why not give it a real shot?

The public hearing will be next Tuesday, March 31st at 1pm in Room 2C of the Legislative Office Building. A committee meeting to decide whether to accept or reject DSS’ waiver application will follow.
Ellen Andrews