Report Calls for Medical Homes, Managed Care

A national commission that was created to study Medicaid reform has recommended medical homes for all beneficiaries and a managed care plan for elderly and disabled patients who qualify for Medicaid and Medicare.

The recommendations (PDF file: 5 pages / 33 KB. More about PDFs.) are among several in the Medicaid Commission's final report, which was released Nov. 17. One recommendation would establish a system to pay for care coordination "premised on a medical home for each beneficiary." Another recommendation would authorize states to implement a Medicaid Advantage managed care plan similar to the Medicare Advantage option but overseen by the states.

Other commission recommendations call for

"It's a mixed bag for family physicians," said Greg Martin, AAFP state government relations analyst, of the report. "The provisions for dual-eligible patients could offer an opportunity to put primary care at the forefront."

However, EHR- or pay-for-performance-related requirements will require careful consideration to ensure physicians receive adequate pay to comply, he added.

The Medicaid Commission was established by HHS Secretary Michael Leavitt in May 2005 to develop proposals for saving $10 billion in Medicaid expenses and to recommend changes that would "ensure the long-term sustainability of the program," according to the commission's charter. (PDF file: 4 pages / 170 KB. More about PDFs.)

In September 2005, the commission submitted its first report, which focused on fiscal savings. The Nov. 17 report focuses on eligibility, benefits design, long-term care, quality of care and program administration.

Given the commission's primary responsibility to identify $10 billion in savings, some members of the incoming 110th Congress have expressed doubts about whether all of the commission recommendations would be implemented.

Sen. Max Baucus, D-Mont., who is expected to take over the chairmanship of the senate committee that has jurisdiction over Medicare and Medicaid, praised the commission for advocating improved quality and encouraging EHRs. However, he told Congressional Quarterly's CQ HealthBeat, "many of its recommendations will undermine federal oversight of the program and reduce the likelihood that the most vulnerable Americans will get the comprehensive health care they need."

Rep. John Dingell, D-Mich., who is expected to be named chair of the House Energy and Commerce Committee, which has jurisdiction over the federal Medicaid program, has dismissed the report outright. "While some in Congress thought this effort would bear fruit, I see no proof of that in this report," he said in a brief statement following the report's release. "It is the job of the Congress to review the Medicaid program and legislate necessary changes, not a hand-picked commission stacked against working families,"