Preliminary Medicaid map would move recipients into 5 regions

State Public Health Officer Don Williamson is overseeing efforts to overhaul how the state's Medicaid Agency delivers services.  (Montgomery Advertiser, Amanda Sowards)

State Public Health Officer Don Williamson is overseeing efforts to overhaul how the state’s Medicaid Agency delivers services. (Montgomery Advertiser, Amanda Sowards)

The Alabama Medicaid Agency has a first draft of a reorganization map, with the state divided into five regions and Montgomery included in one taking in southeast Alabama.

However, Dr. Don Williamson, overseeing the overhaul of the way the agency delivers services, said Friday the number of regions — and the map — could change based on input from the public and providers over the next several months.

“They’re all preliminary maps until the final map gets adopted,” Williamson said in a phone interview. “By the time we get through public comment process, it could be seven, it could be six, it could be four.”

Williamson plans to unveil the maps at a public meeting at 10 a.m. Monday.

The overhaul, approved by the Legislature in early May and signed by Gov. Robert Bentley, authorizes Medicaid to divide the state into regions, each served by a group known as a “regional care organization.” The RCOs would contract with Medicaid to deliver services in their regions if the agency determines the RCOs could deliver the services better than the traditional Medicaid model.

The RCOs could deliver services under a “capitation” model. Instead of a fee-for-service, the organizations would be given a lump sum of Medicaid funds, and would be able to keep a portion of the money if they could provide services under expected costs.

Optumas, an actuary hired by Medicaid, estimates the change would save the state from $48 to $69 million a year when the program is fully up and running, a relatively small portion of the state’s current spending; Medicaid is budgeted to receive $615.1 million in the 2014 General Fund budget, which takes effect Oct. 1. However, Williamson and other officials have said they hope the changes will “bend the cost curve” of the program, which has seen expenses increase as the sluggish economy has increased eligibility.

Williamson said the regions would have between 120,000 and 140,000 Medicaid recipients each. He declined to get into details on the make-up of the regions, but said Montgomery would be tied in with counties in the Wiregrass in the southeast portion of the state.

“Montgomery is a major medical center, and the region is going to be based off the southeast part of Alabama,” he said. “Hopefully we’ve maintained the natural referral patterns to Montgomery.”

Williamson said they will submit a map to the Legislature Reference Service no later than June 20th. The final map will have to be in place by Oct. 1.

– posted by Brian Lyman

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