HCA Update: Reduction in Funds for ACHs

If you’ve been a part of this Medicaid Transformation adventure with the BHT Accountable Community of Health for a while, you’ve probably become very well acquainted with BHT Staff saying, “we don’t know yet!” One of the biggest challenges has been balancing how quickly things change with how slowly information gets pushed out from Health Care Authority on the mechanics of this huge opportunity to shape a more effective health system within our community. Well, on Friday we got some pretty distressing news…
Now, please recognize that we don’t have all of the details yet so we don’t know exactly how this will impact the BHT region but we want to be up front about this new challenge. BHT staff is committed to sharing information as we learn more.
The Health Care Authority submitted the initial application for the 1115 Waiver to CMS two years ago. We have now learned that some of the initial calculations HCA made in that application to meet CMS requirements for matching funds were insufficient. This will mean a reduction in funds available to ACHs.The conservative impact we are hearing now is a 36% reduction in project dollars. HCA was quick to remind us that they have always said we would earn up to $89 million as a region, and that money was never guaranteed…but we certainly didn’t see this coming.
Now we do KNOW: 

  • Cuts will NOT affect the $6 million we’ve earned so far through Phase 1 & 2 certification
  • Cuts will NOT affect the $8.7 million incentive payment if our region votes to be a mid-adopter of Fully Integrated Managed Care by November 18th
  • Cuts will NOT affect the Tribal Partner Planning project 

The $15 million dollars we expected to earn for our Project Portfolio due November 16th will likely be reduced, and we’d estimate currently to $9 million. Does this make the work harder? Sure does. But let’s not forget that still puts over $20 million available to this region in year one to support improved community health, and there is a lot of good to be accomplished with that money. BHT is not intending to slow down, but we may have to sharpen our focus to doing well will fewer resources, and in thinking creatively about how to braid in other funding to support these efforts.  
So what happens next: 

  • We are postponing our 6 vs 8 Project discussion that was scheduled for 10/4 for the ACH Leadership Council until 11/12 at 10am. At this session we’ll have an updated overview to consider 4 vs 6 vs 8 projects
  • On Thursday, 10/5, ACH leaders from around the region are meeting with the HCA to advocate for additional flexibility on Program Requirements. 
  • On Friday 10/6, at 1pm, we’ll host an ACH check in to identify any additional comments or questions that might have come up. You can register for that here: https://attendee.gototraining.com/r/5658971229695803394
  • On Monday, 10/9, our ACH weekly email will provide a quick summary of any new information or changes to our plan. 

Since beginning of the ACH, we were committed to using the available resources to improve our community’s health, to build strong partnerships and a better delivery system. While this no doubt make it a little less fun, we know we can make impact. This is an opportunity to recommit to the ideals and values that will be necessary to make meaningful change. We are going to need to work in a more aligned way and look for deeper more powerful partnership. Our commitment to health improvement for this region isn’t wavering, we hope you’ll stand arm and arm in with us to make Eastern Washington the healthiest region in the state.