Medicaid Reforms

The expansion of Medicaid through the implementation of the Affordable Care Act (ACA) has initiated many states to try innovative ideas to improve their Medicaid programs. Many states, like Minnesota, had started the reform process prior to the passage of the ACA with the purpose of improving the quality of care for Medicaid beneficiaries and to utilize a more cost-effective system to provide Medicaid benefits. One of the innovative ideas that states like Minnesota is implementing is the use of accountable care organizations (ACOs). This paper will explore ACOs by studying the reforms within the Minnesota Medicaid program.

Background

Medicaid was originally established by the government to provide medical services and payment for individuals

After the passage of the ACA, Minnesota was chosen to pilot a Medicaid program using ACOs to improve healthcare delivery because of the previous reforms that were made to the state’s Medicaid system. In 2008, the Minnesota state government passed the Health Care Reform Law which implemented the utilization of health homes to provide Medicaid services and a revision of the state’s quality and monitoring system of the Medicaid program (Edwards, 2013). The law was also expanded to use ACOs after the passage of the ACA, in order to provide more comprehensive care for Medicaid beneficiaries (Edwards, 2013). The use of the ACOs “forged a partnership to redesign the health care workforce and improve the coordination of the physical, behavioral, social, and economic dimensions of care” for Medicaid beneficiaries (Sandberg, Erikson, Owen, Vickery, Shimotsu, Linzer, Garrett, Johnsrud, Soderlund, & DeCubellis, 2014). To ensure the success of the program, the state also developed a safety-net program to ensure that Medicaid recipients would continue to receive quality care to meet their health care needs, if the pilot program

The Minnesota study had supplied advantages and shortcomings of the usage of ACOs for Medicaid service for the state. Since there was a diverse group of patients within the pilot program, the information gained through the evaluation provided a respectable sample to assess the program. One of the challenges that faced care coordinators was housing, social, and vocational issues because of the economic issues some of the patients were facing (Sandberg et al., 2014). Another issue faced within the study was the usage of emergency room for dental pain because of the lack of dental services for Medicaid recipients (Sandberg et al., 2014). While need for dental services was unexpected, collaboration with other health care professionals delivered dental professionals that were willing to offer services to the individuals. Flexible funding also aided in providing services for all of the unexpected services listed above, that were needed to adequately care for the Medicaid recipients (Sandberg et al., 2014). Without the flexibility to reimburse the additional professionals for their services, the patients would have received disjointed care that did not meet their total needs and would have negatively impacted their overall