A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Some More Good Stuff From MMPI

Some More Good Stuff From MMPI

January 17, 2012

Kate Nordahl and the Mass Medicaid Policy Institute keep churning out more good stuff.

Next up are two timely papers:

  1. First is a fact sheet (pdf) on the just-concluded extension of our Medicaid waiver, the agreement with the federal government that allows the Commonwealth to collect federal Medicaid funds for the MassHealth program, Commonwealth Care, and much more. The fact sheet focuses on what's new in this agreement, including the Pediatric Asthma Pilot, the Intensive Early Intervention Services for Children with Autism Spectrum Disorder, the Delivery System Transformation Initiatives, and Express Lane Eligibility, which allows the state to renew eligibility for children families based on their eligibility for SNAP (=food stamps).
  2. Second is a close look at "risk adjustment," (pdf) a wonky but critical detail to be included in the proposal to provide integrated Medicare and Medicaid for adults with disabilities who are in both programs, called the dually eligible. What is risk adjustment? Here's the report's clear explanation:

    Risk adjustment is a system for adjusting payments to health plans to reflect the differing health needs of enrollees, with higher payments made to health plans with members needing more care and lower payments to health plans with members needing less care. Without risk adjustment, providers of integrated care would face strong incentives to enroll the less needy among the duals. By contrast, providers that attract more than their fair share of enrollees with high needs would be underpaid, and could face large financial losses or have to reduce expenditures.

    Risk adjustment for programs serving the dual eligibles should take advantage of diagnostic data complemented by information on functional status.

    The paper explains how best to do this, and why it's particularly vital that functional status be added to the calculations.

Good winter reading, friends.
-Brian Rosman