1. Medicaid Investments in
Primary Care: Fitting The
Pieces Together
AAFP 2011 State Legislative Conference
November 4, 2011
Dianne Hasselman
Director, Quality and Equality, CHCS
www.chcs.org

2. CHCS Mission
To improve health care quality for low-income children and
adults, people with chronic illnesses and disabilities, frail
elders, and racially and ethnically diverse populations
experiencing disparities in care.
Our Priorities
► Enhancing Access to Coverage and Services
► Improving Quality and Reducing Racial and Ethnic Disparities
► Integrating Care for People with Complex and Special Needs
► Building Medicaid Leadership and Capacity
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3. Medicaid Fast Facts
60 million People in the United States with Medicaid coverage.
$427 billion Projected Medicaid spending for FY 2010.
16 - 20 million Additional Medicaid/CHIP beneficiaries by 2019 due to health reform.
41% Births in the United States covered by Medicaid.
28% Children in the United States covered by Medicaid.
50% Medicaid beneficiaries under 65 who are from diverse racial/ethnic groups.
5% Medicaid beneficiaries accounting for 57% of total Medicaid spending.
49% Medicaid beneficiaries with disabilities diagnosed with mental illness.
27% Total mental health care costs financed by Medicaid.
$4 billion Estimated costs for children in foster care covered by Medicaid.
71% Medicaid recipients who are enrolled in managed care.

4. Challenges Facing Medicaid in 2011
• Overwhelming and dire budget situation
• We’re not through the worst of it
• Loss of leadership and staff through early
retirement, hiring freezes, and furloughs
• Low morale, loss of historical knowledge
• Political conflict around implementation of health
care reform
• Federal mandates, state lawsuits, 2014 approaching
quickly
• In the midst of all this, unprecedented opportunities
and funding for Medicaid transformation
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5. Federal Investments in Medicaid Primary
Care
• Primary care rate increase or “bump”
• Health homes and community health teams
• Medicaid preventive care incentives
• Payment demonstrations (Pediatric ACOs and
bundled payment)
• Health information technology and meaningful
use
• Medicaid adult core measurement set
• Comprehensive Primary Care initiative
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6. Section 1202: PCP “Bump”
• In 2013-2014, Medicaid will reimburse primary
care providers
• Infuses up to $8.3 billion in Medicaid primary
care, funded entirely by the federal government
• Applies to physicians practicing in family
medicine, general internal medicine, and
pediatric medicine
• Covers evaluation & management codes
covered by Medicare and child and adolescent
immunizations
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7. Section 2703: Health Homes
• Six new care management/coordination services for
eligible Medicaid beneficiaries
• State participation is optional
• Timing is flexible
• Funding for services is an enhanced – but time limited
– 90/10 federal-state match
• Chronic conditions and geographic locations can be
targeted, phased in
• Focus on integration of physical and behavioral health
care
• Related to, but not the same as, medical home
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8. Accountable Care Organizations
• Medicare shared savings program for
accountable care organizations regulations
released April 2, 2011
• Medicaid pediatric demonstration scheduled for
2012-2016
• Center for Medicare and Medicaid Innovation
opportunities
► Pioneer ACO model opportunity
► Significant state interest in exploring ACOs
► Utah, New Jersey, Maine, Colorado, etc.
► Dr. Jeffrey Brenner’s “hot spots”

9. Comprehensive Primary Care Initiative
• New and competitive initiative by Center for
Medicare and Medicaid Innovation (CMMI)
• CMS to pay care management fee to
participating practices for Medicare fee-for-
service beneficiaries
• PMPM average: $20 Years 1/2; $15 Years 3/4 with
shared savings opportunity
• CMS will fund 100 percent of additional
reimbursement for new or enhanced primary
care services for Medicaid fee-for-service
beneficiaries
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10. Medicaid Leveraging Federal and State
Investments
• Build capacity for Medicaid expansion in 2014
• Invest in primary care delivery
► Leverage new federal dollars, repurposing existing
funds
► Push accountability out towards the point-of-care
• Maximize impact of opportunities by creating a
coherent strategy for Medicaid transformation
► Link, align or “nest” Medicaid initiatives
► Align activities with other payers
• Create stepping stones to a more effective,
accountable health are system
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11. Primary Care Leveraging Medicaid
Investments
• Work in partnership to help Medicaid design and
implement new primary care initiatives
• Outreach to Medicaid director and medical director in
organized way
• Engage in Medicaid medical home initiatives,
encouraging involvement by smaller practices
• Work with Medicaid to measure the return on
investment of efforts – this is the opportunity to
sustain investments
• Identify physician champions for Medicaid
• Above all, resist the temptation to retreat or withdraw
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12. Visit CHCS.org to …
• Download practical resources to improve the quality and
cost-effectiveness of Medicaid services.
• Subscribe to CHCS eMail Updates to learn about new
programs and resources.
• Learn about cutting-edge efforts to strengthen and
invest in the primary care infrastructure for the Medicaid
program.
www.chcs.org
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