State’s One Care pilot to get $47.6M infusion; Fallon exits end of Sept. but two insurers remain
A pilot program run through MassHealth and aimed at controlling costs by providing care management for about 17,000 disabled Massachusetts residents will get an infusion of state and federal dollars to "stabilize" the demonstration over the next two years.
MassHealth reached a deal, announced late Tuesday with the federal government, to update rates paid under a pilot program called One Care, which is being used to provide care management to disabled residents under age 65 who are eligible for Medicare and Medicaid.
Since its launch in 2013 the program had been bleeding money for participating insurers, losing more than $54 million through March, according to the Baker administration, and forcing Fallon Health to announce its plans to withdraw at the end of September.
MassHealth has also requested a two-year extension through 2018 of the demonstration program, which they said would help the agency fully understand the impact of the program.
Commonwealth Care Alliance and Tufts Health Plan, the remaining insurers participating in the One Care demonstration, have agreed to the changes that will impact rates paid for services provided to the dual-eligible population, according to MassHealth.
Commonwealth Care Alliance lost more than $40 million on the program through March, and Tufts paid out close to $1 million more for services than it was paid.
Fallon Health's Total Care plan lost $12.9 million over the first 18 months of the program.
"We have always believed-and continue to believe that this demonstration will ultimately prove to be a highly successful model of integrated care that makes an appreciable difference in the lives of the population it serves," Commonwealth Care Alliance President Lois Simon said in a statement.
In total, an additional $47.6 million in state and federal funding over the next two years will be used to pay "more accurate rates for the complex care management and service needs of low-income adults with disabilities," according to MassHealth.
"We appreciate the strong support from our federal partners and the participating health plans," Secretary of Health and Human Services Marylou Sudders said in a statement. "One Care is pioneering the way care for high-risk populations can be delivered. It is a model that integrates behavioral and physical health care, acute and long-term supports for adults with significant disabilities."
Medicaid will spend an additional $29.8 million in 2015 and 2016, with the state splitting the costs with the federal government and investing $6.7 million this year and $8.2 million next year.
Medicare will contribute an additional $17.8 million over the next two years fully funded by the federal government.
Twelve states, including Massachusetts, are participating in the One Care demonstration, which is due to expire after 2016. Through July, the One Care program had 17,518 enrollees of the more than 100,000 people eligible for participation in Massachusetts.
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