Here are six things to know about the change.
1. Alabama has received a waiver from CMS that will allow the state to create 11 regional care organizations. These RCOs will enroll Medicaid patients with the goal of encouraging preventive care and reducing costs, according to the report.
2. The RCOs, which are expected to go into place Oct. 1, will bear risk and contribute cash to their functions and, in turn, will receive a share of Medicaid money with a goal of shifting the delivery system from a fee-for-service model to a value-based one, according to the Montgomery Advertiser.
3. According to Danne Howard, executive vice president and chief policy officer for the Alabama Hospital Association, the biggest patient pool into the RCOs would be children, the blind and the disabled. Overall, it is expected that the program will enroll 630,000 Medicaid patients.
4. Alabama could receive up to $748 million from the federal government over the next five years to implement the program, according to the report. At least $328 million will go toward setting up the RCOs over three years, with the rest being available if Alabama reaches certain benchmarks.
5. Overall, supporters of the program hope the move will control cost growth and result in better outcomes. “We want to reduce the infant mortality rate,” Alabama Medicaid Commissioner Stephanie Azar said, according to the report. “We want to shift care to more appropriate settings … the entire goal and overall structure of the program is to make healthier lives.”
6. Announcement of the waiver comes as Alabama’s Medicaid program has experienced rapid growth. Since 2007, the program has grown by about 300,000 people, and it currently takes up 38 percent of the state’s general fund budget, according to the report.
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