Top leaders in the Governor's Administration are expressing concern that the current level, and expected trajectory, of Mass Health spending and program direction is unsustainable over the long course.

In earlier Mass Health briefings, Administration leaders note that out of the state's proposed FY 16 budget, $15.3 billion will be spent by Mass Health.

Of the 15.3 Billion spent, $6.7 Billion comes from the State General Fund (SGF) and $8.7 Billion is comprised of FFP (Federal Financial Participation), otherwise known as matching federal dollars, plus provider assessments which increases federal match coming back to the state.

Prior to the 1990's, states invested a greater percentage of their SGF into health and human service programs through programs that were funded exclusively by the states, however over the last 30 years, states have moved their programs away from SGF funded programs and shaped their design, goals and outcomes to attract more and more federal funding.  For poor states, this has been a tremendous fiscal boom providing federal funds for almost 90% of the cost of their human service and health programs.  For Massachusetts, its also been a success ensuring that the federal government is contributing 50% of the cost of most programs.

With the Commonwealth's highly successful and effective embracement of universal health care and a robust human service system, state officials are concerned about how to better predict and control future costs, while also ensuring quality outcomes.

Thus the Administration, led by Secretaries Sudders and Lapore, and Mass Health Assistant Secretary Daniel Tsai are asking for input to determine if more efficiencies can be found, while protecting and improving quality outcomes.

For some, this suggests an expansion or further embracement of managed care, similar to the Commonwealth's One Care program for individuals dually eligible for Medicare and Medicaid.  Studies across the nation credit managed care as an effective tool in keeping medical costs down and focusing on savings through prevention and cost effective case management.

In the long term service and support area (LTSS), there remain many questions raised by stakeholders including:

• with regard to people with I/DD, are there success stories or states that embraced managed care for LTSS and medical services?  As recently as last year, national disability publications suggested the jury was still out on this question.
• if managed care is embraced further, will MCOs or ACOs be given jurisdiction over state institutional programs or state operated services (which generally operate at a much higher cost).  Some in the disability community view the inclusion of the total service system as an advantage in controlling costs and quality, though many states have found this difficult to accomplish due to contractual and political considerations.
• with managed care primarily rooted in medical care and quality metrics, will the principles of self determination, personal empowerment and family stability and control be able to thrive?
• will the unique needs of people with disabilities be understood?  In many states, providers have encountered managed care companies, who have little understanding of disability, attempting to train providers and consumers on person center planning having never participated in such a system.  On some occasions, some MCOs have confused people with I/DD with people with psychiatric disabilities perhaps due to their greater comfort with a medical model framework.

The willingness of Governor Baker and Secretaries Sudders, Lepore,  and Tsai to reach out in a thoughtful process is encouraging.

ADDP members and interested parties are urged to join the conversation today to ensure that the Administration's goal of public input is achieved.

A good reference point for how to build an effective Managed Care Program for People with Disabilities has been published by the National Council on Disability, an independent federal agency that advises the President and Congress on issues impacting the disability community.