This interview is part of KHN's video series "Supreme Uncertainty: What's Next After The Court Rules," which solicits views from public officials and policy experts about the upcoming Supreme Court ruling on the health law and its implications for the future of health care.
KHN's Mary Agnes Carey talks to Michigan Medicaid Director Steve Fitton about how it will be a "struggle" for his state to be ready to implement the health law on schedule if the Supreme Court upholds the measure. But he's confident that Michigan can handle the expected new enrollees in Medicaid. Fitton says Michigan officials want to move beneficiaries with both Medicare and Medicaid into managed care if the law is upheld.
Read an edited transcript of the interview:
MARY AGNES CAREY: As we know, the Supreme Court is expected to rule near the end of June on the constitutionality of the health law. If the Court strikes down the health law, what does that mean for Michigan, and what's next?
STEVE FITTON: I think we keep doing what we've been doing. That would be the status quo. Certainly, there's always interest in moving the health system forward and improving things. The governor has been on record as saying an exchange is a good idea in general – not necessarily the ACA envisioned exchange – but whether he would make that a priority or not, I really couldn't say. I think mostly we’re back to business as usual, and business as usual in Michigan is pretty good in the health care world.
MARY AGNES CAREY: If the law is upheld, how do you see the implementation moving forward [in Michigan]? There's been some concern that some states won't be ready on time. Will Michigan be ready if it's upheld?
STEVE FITTON: I think it will be a struggle. Certainly, if the law is upheld, I think there's enough interest in the state to have it be as state-centric as possible. And so I think we'll kick it into high gear, and those who are much more familiar with the specifics will have to make some decisions about whether we can actually achieve the milestones and do the preparations to have a state-only exchange, or whether we would have to engage in a federal partnership model in some way.
MARY AGNES CAREY: Do you think, since you run the Medicaid program, would you be able to handle that influx of new Medicaid beneficiaries if the law is upheld?
STEVE FITTON: I think we can handle that. We have a lot of planning capacity in this state. Certainly, we're concerned about the eligibility system just being able to process the number of new applicants and have that work in a timely way. But we believe we have the capacity to handle the new beneficiaries and look forward to having health care provided to many of those in need.
MARY AGNES CAREY: Currently, Michigan has, I believe, 75 percent of Medicaid enrollment in managed care. And the health law allows states, on a demonstration basis, to put the dual eligibles – these are the sickest and frailest beneficiaries that quality for Medicare and Medicaid – into managed care. There's been some controversy about this. How do you think Michigan would proceed with the dually eligible?
STEVE FITTON: We're one of the 15 states that requested and received $1 million in planning money about a year ago. We've worked very hard with consumers and advocates and provider groups – all the different stakeholders – to put together a plan for Michigan. And we submitted a proposal at the end of April to the federal government to put the entire dual eligible population – those at least who have full coverage – into this demonstration program because we believe that the care system can be greatly improved.
MARY AGNES CAREY: There is controversy about putting the duals in managed care -- they leave their current provider or their community health center. If the demonstration project doesn't work, they can't go back to those. If there are continued budget pressures on states, the states will go to the federal government and want to cut spending on Medicaid, including those dually eligible. How do you make sure that there are enough providers, that these folks are protected, and that if there are problems that they won't be hurt by them?
STEVE FITTON: We have 70 to 75 percent of our current population in managed care, and that includes all the adult disabled population that's not dual eligible. And we've had that population in mandatory managed care for 15 years in Michigan, so we have a lot of experience with that population. Our emphasis in Michigan is on quality, so when we do procurements, we choose plans based on quality. We actually set price. We have a number of quality components to the program, in terms of doing financial incentives for achieving certain quality benchmarks. We have auto-assignments; our individuals actually don't select a plan.
We advantage the plans that have higher quality to get more of those auto-assignments. We monitor the plans on various HEDIS and CAHPS measures. And we even provide a scorecard, where we rate plans competing against themselves on a one, two and three-star system on different care components that go to beneficiaries to help choose a plan. We don't allow marketing. We have an enrollment broker that's a neutral party that provides objective information – tries to make sure, if an individual has a primary care doctor, they can choose a plan that that primary care doctor participates in. So, we have a lot of safeguards around that. In terms of network adequacy and making sure there are sufficient providers, Medicare has certain standards that they use. We use, I think, similar standards to make sure that there is capacity.
Plans have to have primary care available to enroll someone, because we insist that there be a connection, that an individual beneficiary be attached to a primary care provider so that they have a source of primary care from the get-go. So, we have numerous protections in place that we think we ensure that there’s quality care.