The Alabama Medicaid Agency submitted a report on May 13, 2014 seeking approval for a Section 1115 Demonstration Project from CMS. The report, discusses how Alabama’s Medicaid program serving 999,561 enrollees and providing healthcare to 47 percent of the children in the state.
However, the State Medicaid program reports that 18 percent of the residents between 2008-2013 are living at or below the Federal poverty level. In addition, Medicaid program enrollment has increased over 20 percent due to the economic downturn, the State has the second highest rate of obesity and the seventh highest rate of heart disease nationally, the rate of diabetes in the State is 50 percent higher than the national average, and the State’s rate for hospital admissions, inpatient days, and emergency department visits are 13 percent to 17 percent higher than the national average.
The biggest problem with the state’s Medicaid relates to costs as they continue to rise at an unsustainable rate and is expected to increase. Costs are concentrated in a disproportionately small portion of the population primarily the aged blind and disabled who make up 31 percent of the Medicaid population but account for 66 percent of program spending.
The state hopes that if the demonstration project goes ahead, new approaches will be used to help develop health homes and build upon existing programs. The Section 1115 Demonstration Project intends to be the first to develop a delivery system where RCOs will be paid on a monthly capitated basis to provide Medicaid benefits, provide for care coordination, and develop medical homes.
When operational statewide, the demonstration project will serve about 64,000 Medicaid beneficiaries, including about 113,000 aged, blind, and disabled individuals. Some of the individuals will be mandatorily enrolled and others will have the option to enroll or continue to receive services through the fee-for-service delivery system.
Go to www.medicaid.alabama.govCONTENT/2.0_newsroom/2.7.3.3_1115_Waiver.aspx to view Alabama’s Medicaid Agency submission of their proposal on the 1115 Demonstration proposal.