Long-term Medicaid funding in limbo after lottery fails

Long-term Medicaid funding in limbo after lottery fails

MONTGOMERY, AL (WSFA) - Last Friday, lawmakers saw a lottery bill die just as it was one vote away from going to the people.

The blame was mainly a house amendment that seemed to put into question the legality of dog tracks operating throughout the state, sapping Democratic support.

Barring the other lottery bill, SB 11, being resurrected, it is hard to see a lottery being passed during the special session.

Medicaid right now faces an $85 million hole - an issue expected to be fixed with the BP Settlement bill. However, Medicaid's needs are growing and will likely request more funds for the foreseeable future.

Faced with growing costs, lawmakers face two options: Either find a way to control costs or find new revenue. Lawmakers are pushing to do both, but a lack of funds is holding the plan back.

To control costs, lawmakers approved a plan to transition the state's Medicaid program into a system of Regional Care Organizations. These RCOs would attempt to control costs by changing the payout structure to one based on results and not the number of visits.

To implement these RCOs, Alabama went out and got a wavier from the federal government, which would bring in $748 million in federal funds to help with the transition.

However there is a catch, Alabama has to prove it can fund Medicaid consistently. The long-term funding proof to go ahead with the transition was supposed to be the lottery. Without a lottery, it is unclear what could be a long-term funding solution.

That puts into question whether or not the state can make the transition into a system of RCOs - the one main plan to control Medicaid costs.

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