|
SEARCH | SUBSCRIBE | ||
|
States' Changes Reshape Medicaid June 12, 2006 After
winning greater freedom from federal Medicaid rules, states are moving
aggressively to transform the nation's largest public health insurance
program, adding fees, restricting benefits and creating incentives for
patients to take responsibility for their health. The
changes are just beginning in several states that are being watched
closely by governors nationwide. Those changes are reshaping Medicaid,
which covers 55 million poor and disabled Americans, so that the program
more closely resembles private insurance, rather than a social welfare
system run with a strong, central government hand. Starting
July 1, West Virginia will phase in a redesigned form of Medicaid that
requires patients to sign a "member agreement," promising that
they will keep doctors' appointments, take prescribed medicine and not
overuse hospital emergency rooms. Patients who refuse to sign or to follow
the rules will be eligible for less care. Kentucky
is dividing its Medicaid patients into four categories, depending on their
health and their age, with different benefits for each group. Most adults
will face higher co-payments for medical services and new limits on
prescription drugs. But patients who sign up for a "disease
management" program eventually will be able to earn credits toward
extra "get-healthy benefits," such as eyeglasses or classes to
quit smoking. Florida,
meanwhile, will privatize part of its Medicaid system in September,
directing patients in Jacksonville and Broward County to pick from 19
health plans, each offering different services. In a departure from how
states have reimbursed doctors or health plans, Florida health officials
will rate the health of every Medicaid patient in the two communities and
pay for only as much care as officials predict they should need. "We've
got a whole new dialogue about how health care should be delivered and
financed," said Diane Rowland, executive director of the Kaiser
Commission on Medicaid and the Uninsured, a nonpartisan policy group. The
emerging shape of Medicaid represents a victory for governors of both
political parties and for fiscal conservatives, who argued for years that
states deserved more control over the program so it would place less
strain on their budgets. Some patients advocates, however, warn that the
vulnerable patients Medicaid was designed to help will be less certain to
get the health care they need. Since
its creation in the 1960s, Medicaid has been a shared responsibility of
the federal government and the states. States shoulder more than 40
percent of the cost, which totals $338 billion this year, and have always
had certain freedom to decide how many benefits to cover. But the federal
government has determined many of the program's basic contours. Last
December, Congress granted states broad flexibility to alter benefits,
charge patients more and expand the role of private insurers as part of a
law that will cut federal Medicaid spending by $43 billion in the next
decade. Even before the law, the Bush administration was sympathetic to
states that wanted greater say over how their programs are designed. The
law, called the Deficit Reduction Act, and the administration's policies
have eliminated a hallmark of the program: Until now, every Medicaid
patient within a state has qualified for the same benefits. Medicaid's
new direction borrows ideas from the overhaul of the welfare system a
decade ago. That transformation also decentralized a major piece of the
social safety net, limited government assistance, expanded the private
sector's role and tried to instill self-reliance in low-income people who
had depended on government help. The
Bush administration is encouraging states to embrace the altered view of
Medicaid. "We are trying to be as supportive as we can," said
Mark B. McClellan, administrator of the federal Centers for Medicare and
Medicaid Services. His agency has been coaching states on the changes they
can make -- and swiftly approving states' revisions. When West Virginia's
Medicaid commissioner, Nancy V. Atkins, sent the federal agency the
proposal for the state's redesigned program on April 26, she was startled
that it was approved one week later. Other
states are not far behind the leading edge. South Carolina's governor has
been pushing for changes that would include health savings accounts and
rewards for being a good patient. Oklahoma's legislature has just passed a
bill that would allow the state to pay health plans a defined amount
depending on a patient's health. And a recent Missouri law calls for the
current Medicaid system there to be abolished in 2008; its replacement is
being designed. State
health officials say such changes make sense, particularly because
Medicaid has expanded in many states in recent years from a program that
covered only the very poor and dispossessed into one that includes a
growing share of children -- and sometimes parents -- in working-class
families. The
most basic force behind the changes, though, is that Medicaid costs
continue to increase more rapidly than state revenues. Ray Scheppach,
executive director of the National Governors Association, said the states'
new strategies are a trade-off, imposing "additional co-pays and
small reductions in benefits" to avoid eventually "pushing
hundreds of thousands of women and children off the rolls." Medicaid
directors say they do not expect large savings in the next few years but
hope to curb costs in the long run. They
are emphasizing preventive care and predict that patients will think twice
about how much care to seek if they have to pay a fraction of the bill.
And by specifying different benefits for different groups of patients,
"we are trying to take advantage of a tool that's really been
available in the private sector," said David Rogers, Medicaid
administrator for Idaho, which -- like Kentucky -- is starting next month
to divide patients into "health-needs categories." Like
Florida, several states are trying to steer Medicaid patients into
private-sector health insurance. Arkansas, for example, has just received
federal permission to use Medicaid money to subsidize small companies with
low-wage workers if they begin to offer employee health benefits. The
focus on private-sector insurance and self-reliance is favored by
conservative groups, such as the Heritage Foundation and the Center for
Health Transformation, which was founded three years ago by former House
speaker Newt Gingrich (R-Ga.). "If you look particularly at the
states like Florida that are emphasizing more individual
responsibility," Gingrich said, "they are moving in exactly the
right direction." On
the other hand, Ron Pollack, executive director of Families USA, a
consumer health lobby, said, "Low-income individuals are increasingly
going to be put at far greater risk of not receiving critically important
services that they used to receive." Joan
Phillips, a West Virginia pediatrician, said she worries that, with the
member agreements, children could be denied certain medical services if
"the parent is not motivated or is dysfunctional." And Phillips
said doctors who report to the state that a patient is not following the
rules will face an ethical bind, knowing the patient will lose benefits as
a result. In
Florida, Lori Parham, a state lobbyist for the AARP, worries about
Medicaid patients who are healthy when they join a health plan but later
get cancer, say, or have a heart attack, requiring more expensive
treatment than their plan has been paid to provide. "The question
becomes, will the care be available?" she said. Alan
Levine, secretary of Florida's Agency for Health Care Administration, said
the revised Medicaid will give patients more "emotional buy-in"
by increasing their choices and incentive to take care of themselves,
while eventually saving the state money. "We are doing it for the
right reasons," Levine said. "I just hope it works."
|