Alabama Medicaid

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The Alabama Legislature passed a sweeping revision to Medicaid that replaces the way the program delivers and pays for care with regional managed care operators.

Under the legislation passed Tuesday, the State Medicaid Agency will no longer bear financial risks but will instead assume the role of contract administrators. Savings of $50 million to $75 million over five years and future cost containment is expected.

Privately owned Regional Care Organizations won't deal directly with patients, but will contract directly with doctors to provide care.

The Alabama House will consider a bill that would reorganize the state's Medicaid program.

The bill will be up for final passage in the House of Representative Tuesday.

The bill was recommended by a Medicaid Advisory committee created by Gov. Robert Bentley.

The Medicaid bill will be debated Tuesday with just three days remaining in the 2013 legislative session. The bill replaces the current payment method with the regional care organizations.

Alabama State House
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Lawmakers are trying to ease the financial burden Medicaid places on Alabama by passing a bill designed to streamline the $5.63 billion program's operational system.

The bill under consideration could change the present "fee-for-service" basis of Medicaid payments to a for-profit, managed care plan or a combination of nonprofit and for-profit companies.

The Medicaid Advisory Committee commissioned by Gov. Robert Bentley does not want to use for-profit managed care companies.

A joint session of the Alabama legislature heard a recap of bills intended to provide major changes to the way Medicaid is administered in the state.

Dr. Don Williamson, state health officer, says if the bill passes, eight or so regional care organizations would assume financial risk in exchange for set payments for patient care.

"We are creating a community based care system that moves from a `fee for service/state bears risk' model to a capitated model that puts a third party at risk," he told the group.

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Representatives from community groups and managed care companies are lauding the Legislature's efforts to reorganize Alabama's Medicaid program.

Speakers told House and Senate members Tuesday that the proposal is a major first step, but they also voiced concerns for the bill before it goes to committees for public hearings and revisions.

The bill would change Medicaid from a fee-for-service program to a program where private-sector contractors develop care networks in up to eight regions of the state.

Governor Robert Bentley has announced his support for changes to Alabama's Medicaid system that would impact one out of every five Alabamians.

The Medicaid Advisory Commission advocates changing the basic operating model from a fee-for-service system to a managed care program. Under the proposal, private-sector contractors would develop care networks in eight newly-created regions across the state.

The new framework would aim to offer better service to patients through regional operations that are responsive to local needs, according to the governor.

The Alabama House has approved a bill aimed at cutting down on fraud and abuse in the state's Medicaid program.

The sponsor, Republican Rep. Jim McClendon of Springville, says the bill is aimed at stopping abuse of a program that exists to provide essential health care to the neediest citizens.

The bill was approved by the House on Thursday by a unanimous 99-0 vote. However, debate lasted for about three hours as some members, mostly Democrats, worked to make sure the measure could not be used to deny Medicaid services to legitimate applicants.

AP Photo/Dave Martin

Democrats in the Alabama Senate are having trouble pressing their top issue.

Senate Minority Leader Vivian Davis Figures of Mobile offered a resolution Thursday urging the Republican governor to reconsider his decision not to expand Medicaid. The Senate's Republican leader, President Pro Tem Del Marsh, cut off debate on the resolution by getting it sent to the Senate Rules Committee.

State Health Officer Don Williamson told Alabama lawmakers that money will be available to fund Alabama's Medicaid program at a minimal level through 2014.

But Williamson told a joint meeting of the House and Senate General Fund budget committees Wednesday he did not know where the money would come from after 2014 to run the health insurance program for the economically disadvantaged.

Williamson is also the interim director of the Alabama Medicaid Program.

Alabama's top health officer says state Medicaid is facing a major funding shortfall.

The director of the Alabama Department of Public Health, Dr. Don Williamson, says federal changes will add $30 million to the state's Medicaid funding needs for 2014.

The Anniston Star ( ) reports that state officials didn't know about the additional cost when voters approved using $437 million from a state fund to plug the Medicaid budget in September.

An Alabama health officer says the state's Medicaid program probably will move to some type of managed care system.

The Tuscaloosa News reports ( ) that such a program would operate much like private insurance functions with commercial management companies or community-based care.