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Appropriations draft aims to bridge OneCare/AHEAD gap with targeted primary care payments
Summary
Committee draft includes one-time bridge funding and payment reform items—referencing the governor's recommendation of $10.8 million and committee proposals of $4.6 million and $2.81 million—to cover losses as OneCare ends and the AHEAD model begins.
The House Appropriations Committee's March 19 draft includes targeted funding to help primary care providers transition as the OneCare/all-payer model ends and the AHEAD model is scheduled to begin, committee members said.
Committee staff member Nolan explained that the governor's recommendation includes $10,800,000 to help "bridge the gap between the end of our all payer model and the beginning of the AHEAD model," and the committee's draft proposes additional, more targeted items: a population health management allocation of about $4.6 million (to cover a half-year under earlier requests) and a OneCare primary care transition item of $2,810,000 covering a short portion of the next fiscal year.
Nolan told the committee the AHEAD model is not scheduled to begin until January 2027 and that Medicare participation that helped sustain payments under the all-payer arrangements will not carry through the gap. As a result, committee staff said, some primary care practices face a sudden loss of per-member, per-month payments that helped keep operations viable.
The draft lists two categories: (1) population health management (PHM) funding tied to attributed lives under prior OneCare arrangements, and (2) a proposed comprehensive payment reform or independent primary care prospective payment program to help independent practices. The committee discussed cuts from earlier requests and a reduced duration for some bridge payments (for example, trimming some requests from a half-year to four months).
Committee staff and an email excerpt read into the record by a staff member (Donna Hay) described how the $10.8 million in the governor's recommendation sought to fill the Medicare funding gap for SASH, the blueprint, and other models; the committee is trying to identify what additional pieces are not covered and how much is needed. Committee staff said they are operating under the assumption that some of the requested bridge funding is not Medicaid-matchable.
The chair asked staff to document the expected duration and the precise breakdown so the committee can track any needed budget adjustments later. Nolan agreed to provide a succinct written explanation and staff said some elements would likely be handled as one-time or short-term funding rather than base restorations.
Ending: Committee members instructed staff to produce clearer language and tracking for the bridge funding so any additional months or base adjustments can be handled by subsequent budget adjustments if needed.
