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New option may jump-start health homes in Medicaid
Medicaid programs now have a new option to offer "health homes" to enrollees with chronic conditions, included in the Affordable Care Act (ACA). "The main reason we will see strong interest is that this is a population that is very high-cost, and often goes without needed care," says Jocelyn Guyer, co-executive director of Georgetown University's Center for Children and Families in Washington, DC.
The health home option is a "win-win,"says Ms. Guyer, because it creates the potential for both significant savings and better care.
"There might be some short-term savings, in part because there is such generous federal funding for the first couple of years," she says. "Then in the longer run, it has the promise of changing the way states deliver care to this population."
While short-term savings are likely to be modest, says Ms. Guyer, significant savings should result over the long term if states do a better job of delivering care.
States grappling with dire budget situations, though, may not be able to take on a new and innovative project even if it has the promise of savings, adds Ms. Guyer. "States are so beleaguered at the moment with their budget situations," she says. "They often don't even have enough bodies on the ground to do the basic functions of Medicaid."
However, states may take a limited approach just to get started, says Ms. Guyer. "If states can't bite off the whole thing, they may take a smaller bite," she says. "There may be particular conditions that are just so expensive that it makes sense to use the very limited resources states have to try to set up health homes in those cases," she says.
The challenge, says Ms. Guyer, is for states to achieve savings without resorting to cutting services. "There is no question that the budget situation continues to be serious. The challenge will be to find smarter ways to achieve savings that don't involve cutting tens of thousands of people off coverage," she says. "It's easier to cut adult dental benefits than to start up health homes."
Ms. Guyer points to Health and Human Services Secretary Kathleen Sebelius' Feb. 3, 2010, letter to state governors, which acknowledges the seriousness of the budget problem and offers strategies to achieve short-term savings.
"While some involve cuts that would be harsh for beneficiaries, most would actually improve care, including the health home model," says Ms. Guyer.
The letter indicated that if a strategy appears to be working in one state, they would be willing to fast-track approval in new states, adds Ms. Guyer. "It's a very strong signal that they are willing to work energetically with states to find better smarter ways to achieve savings, without cutting people off," she says.
Contact Ms. Guyer at (202) 784-4077 or firstname.lastname@example.org.