Washington Elder Law Practice Report (#16) / HCA pushes toward “value” contracting

April 23, 2014

Washington Elder LawThis is #16 in a continuing series of Washington Elder Law Practice Reports.

The Washington State Health Care Authority (HCA) is working to change the ways in which state health care services are delivered and purchased. This will impact Medicaid (Apple Health), all other health care programs that are managed by the HCA, and—in a larger sense—all health care services in the state.

The HCA has announced that all Medicaid enrollment targets under the Affordable Care Act (ACA) have been surpassed. As of the end of March, 2014, almost 270,000 new adults had been enrolled in the expanded Medicaid program, while about 135,000 new clients were added “under the old eligibility rules”.

In addition, there were more than 400,000 “successful recertifications” of adults and children, so over 800,000 state residents are now covered by Apple Health.

HCA has been emphasizing that Medicaid enrollment continues on a year-round basis, for those with eligible income levels. Those with too much income for Medicaid are being directed to the second enrollment period for the Health Benefit Exchange, starting on November 15, for private plans with possible subsidies.

The HCA has also made it clear that the state’s Medicaid estate recovery policy will be adjusted to limit recovery to “enrollees 55 and over who are in long-term care….” This will continue the long-term care (LTC) focus for estate recovery that has been in place for an extended period, and clarifies that new enrollees who do not require LTC will not be affected.

The HCA is also taking specific steps to make broad changes in the ways that health care services are delivered.

For example, the HCA and King County have teamed up on a joint Request For Information (RFI) to find out what activities are under way to “provide better and more affordable care” and “increase the overall health….” The idea is to change the ways in which health care services are delivered and funded.

As noted, “over the next five years, HCA will exclusively partner with health care providers and health plans …(that) are actively supporting integrated medical…care and redesigning care and payment systems to provide value to purchasers….”

Attorneys who assist clients with health-law-related issues are likely to be affected by these and similar efforts.

And a push toward “higher value” delivery systems will continue to reshape how services are being delivered across the state.

These ongoing changes will impact all attorneys, as they provide assistance to clients.

Individuals will need up-to-date explanations of how health care is evolving in the State, in order to understand their options.

Providers will need legal support to interpret how program changes will affect their patients and income, and to explore the types of organizational redesigns that they should be considering.

Employers will need advice as to what all of this means for their employees and benefit plans.

And insurance companies will need to watch state activities closely, in order to decide how policies and premiums will be affected.

Elder law practice in Washington is discussed by Cheryl and Ferd Mitchell in volumes 26 and 26A of Washington Practice (Washington Elder Law and Practice and the associated Elder Law Handbook). Probate practice is covered in volume 26B, and also introduced in volume 26.