The Medicaid Advisory Committee commissioned by Gov. Robert Bentley does not want to use for-profit managed care companies, but lawmakers and others are trying to ease the financial burden that Medicaid places on the state budget.
Currently, the state agency pays providers and bears the administration costs. If the proposed shift is implemented, the costs should be contained or lowered for the state, lawmakers said.
By arming the state's Medicaid Agency with a very flexible framework, lawmakers aim to permit officials to create fresh business models.
Choosing from scenarios submitted by the Medicaid Agency's actuary, six to eight regions would be created under the remodeled system. Each region would host a central agency called a regional care organization. That RCO would be a risk-bearing entity capable of contracting with a commercial managed care organization. It could develop a community-based network of providers on its own.
Some large health care corporations made presentations to the Medicaid Advisory Commission on behalf of their industry.
Ryan Sadler of Centene Corporation in Missouri was clear his company wants to provide managed care services.
"We provide services to governments in 21 states and we want to work with Alabama to serve its Medicaid agency. In South Carolina, they wasted a lot of money on patient care networks. They can save that money now by working with us."
Trimming services to patients is not on the table. According to a Kaiser Foundation study, Alabama ranks third from the bottom when it comes to how much the state provides for each recipient's care. The Medicaid Advisory Commission reported that decreasing services would not result in savings, as removal of some care would escalate the need for others. The cost savings would more likely come from the decentralization.
For some, the decisions made in Montgomery can mean life or death.