Moving beyond the health insurance card: the new Medicaid waiver

We recently shared some great news that King County has cut its uninsured rate in half, a victory due in large part to robust outreach and new opportunities under the Affordable Care Act. While we continue efforts to expand access to health care, there is much more work to do to improve health.

This is the focus of the King County Accountable Community of Health (ACH), a cross-sector table  focused on how to make the system work better for all and reverse the profound health disparities in our region.  The ACH received a boost from a federal-state agreement announced last week by Governor Jay Inslee and The Washington Health Care Authority (HCA).

We sat down with Ingrid McDonald, Policy Director at Public Health – Seattle & King County, to learn about this agreement referred to as the Medicaid Transformation Waiver and how it might impact King County.

What is the Medicaid Transformation Waiver?
It’s an agreement from federal government to allow a state to waive certain Medicaid rules and innovate in creative ways to improve care and reduce costs. Waivers enable states to think outside of the box and try new approaches that wouldn’t ordinarily qualify for Medicaid reimbursement. A number of states across the country have used this mechanism. The principled agreement announced last week is essentially a handshake agreement between Washington State and the federal government to use this approach. The details of how this will work are still being sorted out.

Why is it important?

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There’s a growing understanding that we need to think about our health in a way that focuses on the whole-person and moves away from treating a particular ache, pain or health issue in isolation. This agreement signals a commitment to building tighter connections between physical health, mental health and substance abuse services – and paying more attention to the supports people need to stay healthy, both inside and outside of the walls of clinics and hospitals. An example of the types of programs that may be explored include broader use of community health workers; improved care coordination; and hands-on support for those living with chronic health conditions such as asthma and diabetes.

How does it work?
There are three components to the waiver. Two of these components are to provide new benefits under Medicaid—such as new supports for older adults and family caregivers; and supportive housing and employment services for Medicaid clients with the most critical needs. The third component is a commitment to accelerate locally-driven transformation projects through the regional Accountable Communities of Health. Funding for these projects will not be in the form of grants. Rather, projects will be eligible for Medicaid waiver funds only after achievement of negotiated milestones. We expect more information about the parameters for these projects in the coming months

Is this a big deal?
Yes. The five-year demonstration will include $375 million for the new Medicaid benefits and $1.1 billion in incentives for locally-driven delivery system reform, a portion of which will be available for investment in transformation projects throughout King County.  This is a strategic opportunity to sow the seeds for long-term, meaningful reforms that will improve overall population health.

Learn more about the waiver at the Healthier Washington  website.

“This innovative infusion of funds should really jump start many of the transformation ideas that ACH members and stakeholders have been talking about for two years,” said Caitlin Safford, Director of External Affairs and Community Development for Amerigroup Washington, Inc.  “One of the keys to the Waiver’s success will be our collective work to put in place and sustain new care models, which is why we’ve been at the table—ready to help from the beginning.”

“There’s a growing recognition that health care alone is not the answer to improving health. Only by bringing together the many sectors that touch people’s lives—from housing to human services, from managed care organizations to public health—will we be able to make a difference in the health of our communities,” said Patty Hayes, Director of Public Health for King County. “This waiver provides a critical opportunity to accelerate the impressive groundwork already established by the King County Accountable Community of Health.”