Provider Withdrawals Spark Uncertainty About Alabama’s Medicaid Overhaul

 ========= Old Image Removed =========Array
(
    [_wp_attached_file] => Array
        (
            [0] => 2016/11/4952166117_a1683a1242_stethoscope.jpg
        )

    [_wp_attachment_metadata] => Array
        (
            [0] => a:5:{s:5:"width";i:500;s:6:"height";i:366;s:4:"file";s:45:"2016/11/4952166117_a1683a1242_stethoscope.jpg";s:5:"sizes";a:7:{s:6:"medium";a:4:{s:4:"file";s:45:"4952166117_a1683a1242_stethoscope-336x246.jpg";s:5:"width";i:336;s:6:"height";i:246;s:9:"mime-type";s:10:"image/jpeg";}s:9:"thumbnail";a:4:{s:4:"file";s:45:"4952166117_a1683a1242_stethoscope-140x140.jpg";s:5:"width";i:140;s:6:"height";i:140;s:9:"mime-type";s:10:"image/jpeg";}s:9:"wbhm-icon";a:4:{s:4:"file";s:43:"4952166117_a1683a1242_stethoscope-80x80.jpg";s:5:"width";i:80;s:6:"height";i:80;s:9:"mime-type";s:10:"image/jpeg";}s:13:"wbhm-featured";a:4:{s:4:"file";s:45:"4952166117_a1683a1242_stethoscope-500x338.jpg";s:5:"width";i:500;s:6:"height";i:338;s:9:"mime-type";s:10:"image/jpeg";}s:18:"wbhm-featured-home";a:4:{s:4:"file";s:45:"4952166117_a1683a1242_stethoscope-425x311.jpg";s:5:"width";i:425;s:6:"height";i:311;s:9:"mime-type";s:10:"image/jpeg";}s:22:"wbhm-featured-carousel";a:4:{s:4:"file";s:45:"4952166117_a1683a1242_stethoscope-362x265.jpg";s:5:"width";i:362;s:6:"height";i:265;s:9:"mime-type";s:10:"image/jpeg";}s:14:"post-thumbnail";a:4:{s:4:"file";s:45:"4952166117_a1683a1242_stethoscope-125x125.jpg";s:5:"width";i:125;s:6:"height";i:125;s:9:"mime-type";s:10:"image/jpeg";}}s:10:"image_meta";a:12:{s:8:"aperture";s:1:"0";s:6:"credit";s:0:"";s:6:"camera";s:0:"";s:7:"caption";s:0:"";s:17:"created_timestamp";s:1:"0";s:9:"copyright";s:0:"";s:12:"focal_length";s:1:"0";s:3:"iso";s:1:"0";s:13:"shutter_speed";s:1:"0";s:5:"title";s:0:"";s:11:"orientation";s:1:"0";s:8:"keywords";a:0:{}}}
        )

    [_imagify_optimization_level] => Array
        (
            [0] => 1
        )

    [_imagify_data] => Array
        (
            [0] => a:2:{s:5:"stats";a:3:{s:13:"original_size";i:221796;s:14:"optimized_size";i:122892;s:7:"percent";d:44.590000000000003;}s:5:"sizes";a:9:{s:4:"full";a:5:{s:7:"success";b:1;s:8:"file_url";s:73:"https://news.wbhm.org/media/2016/11/4952166117_a1683a1242_stethoscope.jpg";s:13:"original_size";i:89077;s:14:"optimized_size";i:37576;s:7:"percent";d:57.82;}s:9:"thumbnail";a:5:{s:7:"success";b:1;s:8:"file_url";s:81:"https://news.wbhm.org/media/2016/11/4952166117_a1683a1242_stethoscope-140x140.jpg";s:13:"original_size";i:6002;s:14:"optimized_size";i:4523;s:7:"percent";d:24.640000000000001;}s:6:"medium";a:5:{s:7:"success";b:1;s:8:"file_url";s:81:"https://news.wbhm.org/media/2016/11/4952166117_a1683a1242_stethoscope-336x246.jpg";s:13:"original_size";i:17975;s:14:"optimized_size";i:11920;s:7:"percent";d:33.689999999999998;}s:9:"wbhm-icon";a:5:{s:7:"success";b:1;s:8:"file_url";s:79:"https://news.wbhm.org/media/2016/11/4952166117_a1683a1242_stethoscope-80x80.jpg";s:13:"original_size";i:2844;s:14:"optimized_size";i:2121;s:7:"percent";d:25.420000000000002;}s:13:"wbhm-featured";a:5:{s:7:"success";b:1;s:8:"file_url";s:81:"https://news.wbhm.org/media/2016/11/4952166117_a1683a1242_stethoscope-500x338.jpg";s:13:"original_size";i:36508;s:14:"optimized_size";i:22543;s:7:"percent";d:38.25;}s:20:"wbhm-featured-square";a:5:{s:7:"success";b:1;s:8:"file_url";s:81:"https://news.wbhm.org/media/2016/11/4952166117_a1683a1242_stethoscope-300x300.jpg";s:13:"original_size";i:17825;s:14:"optimized_size";i:10972;s:7:"percent";d:38.450000000000003;}s:18:"wbhm-featured-home";a:5:{s:7:"success";b:1;s:8:"file_url";s:81:"https://news.wbhm.org/media/2016/11/4952166117_a1683a1242_stethoscope-425x311.jpg";s:13:"original_size";i:26044;s:14:"optimized_size";i:15891;s:7:"percent";d:38.979999999999997;}s:22:"wbhm-featured-carousel";a:5:{s:7:"success";b:1;s:8:"file_url";s:81:"https://news.wbhm.org/media/2016/11/4952166117_a1683a1242_stethoscope-362x265.jpg";s:13:"original_size";i:20356;s:14:"optimized_size";i:13429;s:7:"percent";d:34.030000000000001;}s:14:"post-thumbnail";a:5:{s:7:"success";b:1;s:8:"file_url";s:81:"https://news.wbhm.org/media/2016/11/4952166117_a1683a1242_stethoscope-125x125.jpg";s:13:"original_size";i:5165;s:14:"optimized_size";i:3917;s:7:"percent";d:24.16;}}}
        )

    [_imagify_status] => Array
        (
            [0] => success
        )

)
1654696028 
1479449786

Alabama’s effort to transform its Medicaid system took a hit last month as several major providers decided to withdraw from the effort. More than a million people in the state depend on Medicaid for healthcare. The pull out is adding uncertainty to what’s already been a troubled process.

Here’s what’s been happening.

The price tag for Medicaid, which offers health care for low income Alabamians, keeps going up. State lawmakers have struggled for years to fund their part of the system. So about three years ago they decided to move Medicaid to a managed care system. The goal was to slow the financial growth.

That meant Alabama would be divided up into regions overseen by Regional Care Organizations or RCOs, basically a network of clinics and hospitals. The state would pay these groups a set amount to cover Medicaid patients and by better coordinating care, the idea is that the RCOs would be more efficient and save money.

It’s just been hard to take that idea and make it a reality.

“We were supporters of the RCO system and we believe it’s a good thing for Alabama,” says UAB Health System CEO Will Ferniany.

But Ferniany says state lawmakers haven’t adequately funded it. Providers are expected to sign a three-year contract. Ferniany says there’s only money in place for about a year.

“It’s just too much risk for this organization to take,” says Ferniany.

So, in his words, UAB Health System has “indefinitely postponed” participation in the RCOs, meaning they could rejoin if conditions change. Providers in three of the eleven RCOs have withdrawn over funding concerns.

Alabama Medicaid Commissioner Stephanie Azar did not respond to a request for an interview, but a spokeswoman tells the Birmingham Business Journal the new system is still on track to start July 1st, itself a delayed date. Others aren’t so sure.

“Frankly, what we need to do is we need to get together and find another, a different, a better solution to this issue,” says Mike Warren, CEO of Children’s of Alabama.

Warren says the current plan has changed from what was originally discussed and he can’t support it anymore. Children’s is not part of the RCOs but with 65-percent of its patients on Medicaid, Warren says they depend of the system’s stability. He says lawmakers’ band-aid approach to funding makes long-term planning hard. (Children’s of Alabama is a WBHM underwriter.)

Joan Alker researches Medicaid at Georgetown University. She says there’s not much evidence managed care actually saves money. Plus she says most people covered by Medicaid in Alabama are children and they’re the cheapest to insure anyway. It’s those with chronic illnesses or the disabled that cost more money.

“You’d really have to zoom in on that population and try to manage their care better to try and achieve some savings,” says Alker.

Republican State Senator Trip Pittman, chair of the Senate General Fund Budget Committee, doesn’t blame the providers for stepping away. He thinks the Medicaid overhaul needs a time out. He says the state has no additional money to give to Medicaid nor is there the political will to raise revenue. He’s looking to Washington to loosen regulations.

“The reality is the State of Alabama needs to balance its budgets and the federal government doesn’t, but they’re the ones that makes the rules and sets all the requirements for their programs,” says Pittman.

President-elect Donald Trump said during the campaign he favors block grants to states to fund Medicaid. It’s something Republicans generally support. Advocates for low-income families fear it would lead to reduced care. But what a Trump Administration would actually do remains unclear. It’s all part of the uncertainty around Alabama’s Medicaid program.

Photo by jasleen_kaur

 

India (and its kids) are out to conquer the world of chess

Chess is seeing a global resurgence, sparked by The Queen's Gambit and the pandemic impact on leisure time. India is an emerging power player, with 85 grandmasters and intense chess schools for youth.

Colombian Presidential hopeful shot at Bogotá rally

A Colombian Presidential hopeful in critical condition after being shot during a campaign rally in Bogotá on Saturday. The assassination attempt is having a chilling effect in Colombia where security has been backsliding recently.

How a network of women in Latin America transformed safe, self-managed abortions

An underground network of feminists and activists developed new models of care for abortion that eventually helped legalize abortion in countries across Latin America.

NPR readers share stories of love and adversity in honor of Loving Day

June 12th is Loving Day, a holiday that commemorates the Loving v. Virginia case, which allowed interracial marriage in all parts of the U.S. NPR readers share how the case changed their lives.

Chile’s Indigenous fishermen say the salmon industry threatens their way of life

Salmon farming is big business in Chile, and the U.S. is one of its largest markets. Yet the fish are not native, and fishermen say salmon are damaging ecosystems and an Indigenous way of life.

Recovery Failure: Why we struggle to rebuild for the next storm

NPR and the PBS series Frontline investigate the forces keeping communities from building resiliently, and the special interests that profit even when communities don't. 

More Front Page Coverage