Best Practices in Medicaid - Alaska

The Center for Health Transformation is inviting leaders from all 50 states to share their transforming solutions for the Medicaid program. In order that key decision-makers and industry leaders from around the country may learn from others’ successes, it is our intention to provide this interactive resource for showcasing the most innovative practices in the country. Please note that the following contributions have not been edited by CHT staff and will remain open indefinitely to future updates.

View Alaska Official Medicaid website >>

Consumer-directed care demonstrations (include number of beneficiaries served now and in any expansion plans)

Alaska Medicaid secured four Home and Community Based Waivers in the 1990s to serve Older Alaskans, Mentally Retarded/Developmentally Disabled, Children with Complex Medical Conditions, and Adults with Physical Disabilities. Personal Care was added as a state plan service in 1986. Changes to allow more Personal Care outside the home and providing for more consumer participation resulted in rapid growth from 1,300 clients in state fiscal year 2000 to about 3,800 clients in fiscal year 2005. While Alaska has a significant service array as alternatives to nursing care, hospital, and intermediate care facilities for the mentally retarded, services have developed to meet immediate needs, with no over-arching infrastructure and with little planning for how all of these services fit together into a seamless system of care

Delivering high quality, coordinated, long term care for the disabled and/or the infirm

To ensure that Alaska’s systems of care are and remain cost effective, quality options that support the ability of the elderly and individuals with disabilities to live within their communities in the least restrictive settings possible, Alaska procured an external contractor to evaluate the long-term care system. The contractor is reviewing home and community based waiver systems, assisted living homes, personal care attendants, nursing and pioneer home services, and senior and community grants. A key part of the study is to summarize and analyze current costs and suggest methodologies and rate-setting structures to incorporate into regulation, allowing improved fiscal responsibility and service delivery systems. The final report will be completed in February and will be shared with the state’s policymakers for consideration as we begin to reshape the long-term care system to meet the state’s long-term care needs.

An additional contract for caseload forecast modeling was secured. The preliminary results of this caseload modeling show a significant shift from medical assistance for children to seniors due mainly to demographic shifts. The final results of this study will be presented to the legislature in mid-February. Together, both studies frame the issue of an approaching long-term care crisis and offer some ideas to the state about how to reconfigure the current long-term care service array to most efficiently and effectively meet the challenge of providing affordable and sustainable long-term care services to Alaskans.

We intend to learn from these reports and other states’ experiences about the role consumer-directed services may play in our future long-term care system and what best practices may assist Alaska in delivering quality, coordinated, and cost efficient long-term care services over the next 10 to 20 years.

Transparent and publicly-accessible measurements of patient outcomes and/or quality

Alaska Medicaid is joining a multi-state collaboration for the purpose of obtaining high quality evidence to support benefit design and coverage decisions. States with small populations and budgets do not have the resources to effectively determine best practices in the rapidly changing health care arena. This collaboration will hire an operating entity that will provide and staff an information clearinghouse and perform policy/evidence consultations, perform or contract for systematic reviews of research and technology assessments, and do systematic reviews of existing evidence. All of this work will allow the participating states to identify, develop, and implement best practices in areas of health care relevant to their Medicaid programs.

Efforts to combat fraud and abuse

In addition to the required Surveillance Utilization Review System (SURS) reviews and the newly imposed Payment Error Rate Measurement (PERM) audits beginning in 2007, state law requires additional provider audits to be done annually by a contractor.

What changes would you make to the federal Title XIX so that you could provide better services to individuals and families on Medicaid in your state?

States need flexibility to determine the service array they will provide and which citizens they will cover under Medicaid. Title XIX, as currently written, restricts state’ abilities to serve more of their low income populations. The current program works for those persons that fit a category of eligibility, while other desperately poor that don’t fit into a category get nothing. Many states are interested in breaking away from the rigid categories to implement programs that will provide an affordable service array to more residents in true need. The “amount, scope, and duration” requirements of the current law preclude this.

Whereas the Centers for Medicare and Medicaid Services (CMS) was generally perceived by states to be a partner in past years, the last five to six years have seen increased instances of withholding approval on state plans, denials, delays, and threatened fund deferrals. There is less consistency among the states than ever before. It would be so much better to administer such an important program in an atmosphere of mutual trust and cooperation.

What are your future plans?

We plan to use the results of the forecasting and long-term care studies and work with the political process to configure a long-term care system that will be sustainable and meet the needs of all Alaskans.