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Medicaid News and Information
Patients Key to Latest Medicaid Reforms as States
Roll Out Money-Saving Plans
'Healthier beneficiaries are cheaper than sicklier
ones' is the theme
By Daniel C. Vock, Stateline.org Staff Writer
 October
3, 2006 - Medicaid reform is arriving with a splash in
Jacksonville and Ft. Lauderdale, Fla. It’s being plugged in radio
commercials, touted on billboards and talked up with church groups. All
of the hype aims to prep recipients so that, from the moment they
receive a bright lime-green and blue envelope in the mail, they feel
they’re joining the cause.
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Related Stories |
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Idaho Becomes First State with Approved Medicaid
Reform Plan
States have sweeping new options
to design
Medicaid programs
May 26, 2006 - Medicaid beneficiaries in Idaho will
be among the first in the nation to have benefits designed to meet their
needs based on age and health status -- changes allowed by the Deficit
Reduction Act of 2005 (DRA), HHS Secretary Mike Leavitt announced today.
Prior to enactment of the DRA states could not target benefits to one
certain group of enrollees.
Read more...
Help in Understanding New Medicaid Regulations
Provided Online
ElderLawAnswers.com looks at details of new
transfer rules
April 24, 2006 – Most senior citizens would prefer
to pay their own way as they are forced to seek professional help in
dealing with the deterioration of mind and body that is inevitable with
aging. Unfortunately, many cannot afford it and must turn
to Medicaid for help. ElderLawAnswers.com this week looks at the new laws
pertaining to asset transfers that may be necessary to qualify for
Medicaid. Read
more...
National Governors Meeting
Governors Unite Behind Medicaid Reforms
Hope to budge polarized, paralyzed federal government
By
Kathleen Hunter,
Stateline.org Staff Writer
July 19, 2005 - The nation's governors presented a
staunchly bipartisan front here over the weekend, repeatedly painting a
sharp contrast between their collaborative efforts and what Arkansas
Gov. Mike Huckabee (R) termed the "polarized and paralyzed" federal
government in Washington. Read
more...
States Scramble to Follow Medicaid ID Law by July 1
46 million poor on Medicaid
must
produce citizenship documents
By Daniel C. Vock,
Stateline.org Staff Writer
June 20, 2006 - Health officials in many states
warn that a federal law requiring Medicaid recipients to prove
citizenship starting July 1 could lead to long lines, dropped coverage
and general confusion for the program's participants.
Read more...
Read more
Medicaid News |
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The first of about 210,000 people in Duval and
Broward counties have begun to take part in Florida’s newest Medicaid
experiment. The goal is to give patients incentives to make smart
choices about their own health care, making them the driving force in
keeping costs down for taxpayers.
Florida’s two-county pilot program is at the
forefront of efforts around the country to give Medicaid beneficiaries
more control over their health care. But Idaho, Kentucky and West
Virginia all rolled out programs this summer that vary in specifics but
adopt the same approach to saving taxpayers’ money. South Carolina hopes
to follow suit as soon as federal regulators sign off on its plans.
Federal approval is needed because the state and
federal governments jointly run – and pay for – Medicaid, an insurance
program that covers 59 million poor Americans, including families, the
elderly and disabled.
In the two Florida counties, enrollees will choose
from one of several health insurance plans. Like their private
counterparts, those plans will offer different menus of doctors, covered
prescriptions and co-payments.
As in the private marketplace, the plans will
compete against each other for customers. The state is offering insurers
a set amount of money to cover each patient, and the plans are offering
packages based on that price.
“There’s more competition in Duval and Broward
counties among plans, therefore, what that equates to is a better deal
for Medicaid recipients,” said Florida Medicaid Director Tom Arnold.
He noted that several of the plans offer full adult
dental coverage, including cleanings and fillings, a benefit Florida’s
Medicaid program never before has covered.
Meanwhile, Medicaid recipients can earn up to $125
a year to use for medical supplies, such as over-the-counter medicines.
They can accrue those benefits by engaging in healthy behaviors, such as
showing up for doctor’s appointments, undergoing routine screenings,
losing weight or quitting smoking.
Rewards for healthy behaviors are a common thread
among the states championing consumer-directed health care.
Healthier beneficiaries are cheaper than sicklier
ones. A patient who actively manages his diabetes, for example, is less
likely to need expensive emergency care.
So West Virginia is now requiring Medicaid
recipients in three counties to sign a member agreement that lays out
both the member’s rights and responsibilities.
Members are automatically signed up for a basic
plan that has fewer benefits than the state’s normal Medicaid package.
But if they sign the agreement and follow its tenets, they can receive
extra benefits, such as mental health services and greater prescription
drug benefits.
Kentucky plans to offer expanded benefits for
patients who faithfully follow disease management programs. So, for
example, someone who keeps up with treatment for his asthma or obesity
could earn credits toward dental and vision care.
Idaho offers a medical savings account for users.
Healthy behavior can earn them money to pay premiums (for the few who
have to pay them) or to cover smoking cessation or dieting services.
“Part of our idea here is to try to create a system
that is more health-driven instead of sick-driven,” said Ross Mason, a
spokesman for the Idaho Department of Health and Welfare.
There’s also another component that links the state
efforts. Each is beginning to treat different types of beneficiaries
differently.
Until February, states generally had to offer the
same Medicaid benefits to all recipients, including poor children and
their parents, low-income seniors, the blind and disabled.
But the Deficit Reduction Act, which President Bush
signed in February, allows states to tailor their benefits to different
populations.
Florida, which designed its plan before the new
federal lawtook effect, is moving toward a system in which the state
will pay private plans more money per patient for the costly
populations, such as the elderly and disabled, than for healthier
patients.
It is the only state so far to use competition
among private insurers as the centerpiece of its Medicaid reform.
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New York State Gets $1.5 Billion from Feds to Change
Medicaid Program
New Medicaid programs bumping along as states
implement change
 October 3, 2006 – Medicaid, for most people, is
somewhere below the radar. For senior citizens, many already at the
poverty level and many more who seeing poverty as a possibility as
healthcare costs eat away modest savings, Medicaid is a "god-send." This
program that provides healthcare for those in need, however, is going
through massive change to meet new federal mandates. And the feds are
serious – Health and Human Services has agreed to pay New York state
$1.5 billion to make reforms. The daily report by KaiserNet.org looks at
how things are changing in other states, too.
Read more...
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Kentucky is splitting its Medicaid program into
four pieces. In addition to its current two main programs geared toward
children and the general Medicaid population, Kentucky is offering a
program with benefits geared for elderly patients who also are covered
by Medicare, the federal insurance program for seniors. A proposed
benefits package for the mentally retarded and disabled still needs
federal approval.
Idaho is rolling out a similar strategy creating
three different categories for coverage instead of four.
Both states hope they can save money by offering
different populations the services they’re most likely to need, without
having to offer them to everyone receiving Medicaid.
There are limits to how much those strategies might
save,pointed out Barbara Edwards, a former Ohio Medicaid director and
principal in the consulting firm Health Management Associates.
The most expensive Medicaid patients are also its
most vulnerable: seniors in nursing homes, and disabled children and
adults. For the most part, though, the Deficit Reduction Act protects
those patients from benefit cuts, higher co-payments and other
money-saving techniques, she said.
“Don’t think you’re going to see a lot of budgets
balanced as a result of being able to slightly modify the benefit
package for healthy people, or in the case of Kentucky … saying healthy
adults can’t get (mental retardation) benefits, when they weren’t
getting (mental retardation) benefits in the first place,” Edwards told
reporters at a
Capitolbeat conference in
August.
Plus, there is still an ongoing debate over how
adept Medicaid recipients will be in taking greater control of their
health care choices.
Anne Swerlick, deputy director of Florida Legal
Services, said she’s concerned that many Medicaid recipients in Duval
and Broward counties don’t know about the impending changes, despite the
state’s media campaign.
She also said the process can be confusing for
recipients who do try to navigate the coverage choices. The comparison
charts provided by the state (available
here) can be confusing and
leave out key details, such as which services require preauthorization,
she said.
Counselors who are trained to help the
beneficiaries often don’t have up-to-date information from the plans,
she added.
Joe Rogers, a top official for the North Broward
Hospital District, a public hospital system that includes 30 health care
facilities in the Ft. Lauderdale area, said Medicaid recipients were
having a tough time, at least initially, becoming active consumers.
Many show up for treatment not knowing which plan
they’re covered by, he said. And one patient who left North Broward’s
coverage to get free diapers under another plan came back when she
realized her doctor wasn’t covered by the competing plan, Rogers said.
Still, Kentucky Gov. Ernie Fletcher (R), a former
physician, told a gathering of
health policy experts in
Washington last week that Medicaid recipients can make better decisions.
“Having worked with them, some folks felt that
maybe they’re not capable of managing their own health care, but believe
me, I think that is a myth that needs to be dispelled. An individual
with the proper incentives and the proper education can take a very
active role in managing (his) health care,” Fletcher said.
Related stories by Stateline:
●
Medicaid cuts, welfare reform target
poor
●
Medicaid: Biggest insurer is a budget
buster
●
States weigh Medicaid incentives
Comment on this story in the space below by
registering with
Stateline.org, or e-mail your feedback to our
Letters to the editor section
at
letters@stateline.org.
Contact author Daniel C. Vock at
dvock@stateline.org.
> Original story at Stateline.org –
click here.
Stateline.org is an
independent element of the Pew Research Center and is based in
Washington, DC. In addition to our online news gathering activities, it
periodically publishes printed reference materials that are free for the
asking, including a State of the States report released every January.
They also sponsor professional development conferences and workshops for
the news media, including the annual conference of CapitolBeat, the
Association of Capitol Reporters and Editors. For further information,
email
editor@stateline.org or call 202-419-4470.
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