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MONTGOMERY, Ala. (AP) — The Centers for Medicare and Medicaid have approved Alabama's plan to switch its Medicaid program to managed care, Gov. Robert Bentley announced Tuesday.
The federal blessing capped three years of work on the proposed overhaul, including back-and-forth negotiations over whether the state would adequately fund the health care program for the poor and disabled.
Instead of the traditional fee-for-service health care delivery model, Alabama plans to contract with 11 regional care organizations to provide care and case management services for patients. Bentley said while tamping down growing Medicaid costs was a major reason for the change, state officials hope it also will provide better outcomes for patients.
"We want our patients, in the state, who are on Medicaid to be healthier. We want to give them the opportunity to better themselves," Bentley said.
The state will debut the new system on Oct. 1. About two-thirds of Medicaid patients, or about 650,000 people— mostly children and disabled adults — will receive care through the regional care organizations.
The organizations will assign a primary-care doctor to each patient and might provide additional services such as transportation to assure that the low-income patients are able to get to appointments.
The organizations will get a flat fee, based on the patients' history and diagnosis. Bentley, a dermatologist, said many Medicaid patients lack a primary-care doctor and end up in the emergency room because of unmanaged conditions. That, he said, drives up costs for the program.
Medicaid patients in nursing homes and foster children are not included in the new system.
The approval from the Centers for Medicare and Medicaid comes with a condition: Bentley said federal officials want assurances that the state will continue to adequately fund Medicaid even in times of state budget difficulties.
Bentley has proposed a $100 million funding increase for Medicaid in the next fiscal year, the minimum amount the governor's office has said is needed to maintain Medicaid services and continue the transition work.
The Centers for Medicare and Medicaid also agreed to provide $328 million over the next three year to help with the transition.
Medicaid Commissioner Stephanie Azar said there was still much work to be done to implement the program, but called it a "giant step in the right direction."
She said the agency will start rolling out information to patients soon.
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