The WV Serious Illness Collaborative met on September 26th and was joined by members of Maine’s State Advisory Coalition, Kandyce Powell, Dr. Lauren Michalakes and Representative Margaret Craven. The purpose of the meeting was to find out more about the implementation of Maine’s legislation, LD1064, which creates a palliative care benefit in MaineCare, the Maine Medicaid program.
There was a unanimous vote to enact this legislation in 2020, but initial attempts failed in 2018. More education was provided and a report was requested. This benefit will be a value-based bundled rate for interdisciplinary palliative care. The benefit will improve quality and value. Maine’s eligibility criteria will not be as restrictive as California’s. They don’t want to limit the benefit to certain diagnoses or to prognosis, but rather to offer it to those in need.
Using national data, the Maine Coalition was able to show that a palliative care benefit will not impose extra costs, but will provide value by helping people remain at home. The cost of emergency room visits and hospitalizations is greater than home and community-based services. Dr. Michalakes called this benefit a “no brianer” as we are already seeing the benefits from hospice and we are already doing this by using many medical codes. This is the right time and the pandemic has highlighted the needs.
The West Virginia Collaborative members were very appreciative of the Maine team’s support and all that they shared. Many of their questions were answered and next steps established.
West Virginia’s legislation to create a palliative care benefit was drafted in 2021 with similar language, but the bill has not yet been introduced. Many communities in West Virginia have some access to palliative care from doctors or nurse practitioners. Funding for an interdisciplinary model would greatly benefit patients with serious illness and those caring for them.