State hears input on Medicaid conversion

Cold, rainy weather was no deterrent to the 200 people who crowded into the Springfield Conservation Nature Center on Nov. 10 to give input on converting the state's Medicaid program to managed care.

"The Springfield Nature Center at one point was completely full; I walked in and could not find a place to sit," said Brian Hauswirth, communications director for the Missouri Department of Social Services.

Four regional meetings held Nov. 10-12 in Springfield, Branson, Joplin and West Plains, drew a total of 400 attendees.

Dr. Ian McCaslin, director of MO HealthNet, led the Springfield meeting.

"I think the variety of opinions expressed were overwhelmingly from mental health providers in the region who are serving MO HealthNet children," McCaslin said of feedback from the Nov. 10 event.

Previously known as the Division of Medical Services, MO HealthNet purchases and monitors health care services for the state's Medicaid population.

Missouri managed care

MO HealthNet established its managed-care model in 53 counties across the central part of the state between 1995 and 1997, when the program was known as MC+ Managed Care. The name was changed to MO HealthNet Managed Care in September 2007.

In January, MO HealthNet began expanding its managed-care system, converting another 36,000 participants in 17 counties - including Bates, Cedar, Polk and Vernon.

Pending support from the governor's office and the General Assembly, Medicaid could be converted from fee-for-service to managed care in up to 21 southwest Missouri counties by July 2010. Such a change would affect around 100,000 program participants, more than 24,000 of them in Greene County alone.

While managed care was originally touted as a cost-cutting or cost-containment measure, the rationale is now focused on greater accountability, better access to care and better quality of care.

"There is an element of cost savings, but that is a very minimal component of the program and is not in any way the chief reason for converting to managed care," McCaslin said. Medical costs are going up across the board, whether people are in managed care or not, he added.

"What you are better able to provide - and the cornerstone of managed care - is primary care and preventive care," McCaslin said.

Catching and treating conditions early, including chronic conditions such as asthma and diabetes, can make children healthier and keep them out of emergency rooms and hospital beds. "That's our main goal: better health status for each of the patients served," McCaslin said.

Like any managed-care program, however, MO HealthNet requires participants to work with physicians in specific networks, which may force patients to change doctors. Also, some individuals may have to pay copays.

For families already receiving Medicaid assistance, "there's no change in eligibility levels," McCaslin said. "Conversion to managed care does not put anybody new on the rolls, and it doesn't kick anybody off. The same health care services are provided under managed care."

Providers weigh in

Local providers were concerned with managed care's impact on their ability to keep serving children, McCaslin said, and specifically, they wanted information on the rates the plans pay, access to services and administrative processes.

But behavioral health professionals said they also are deeply concerned about access to care for adults and for patients who now receive services as children but will soon be older than 18.

"I wanted to know how MO HealthNet was going to affect people currently on Medicaid and how that would impact their being able to access services," said Jay Robards, a case manager for Burrell Behavioral Health's Homeless Services, who attended the Nov. 10 meeting.

Robards said the meeting was "pretty much a confirmation of what I had heard from other colleagues in that managed care is really not something that we want to have in this area, because it will restrict availability of services for adults."

Springfield area mental health providers also called for MO HealthNet to add a behavioral health professional to its oversight committee.

Meanwhile, in meetings across the region, individuals raised concerns about how the shift could affect foster families, children with special needs, substance-abuse programs and dental services. Hauswirth noted that testimony from the southwest Missouri meetings will be posted to www.dss.mo.gov. The earliest a conversion to managed care would happen - assuming full legislative support - is mid-2010.