Considerations
Medicaid Considerations
In order to insure the long term viability of the Medicaid Program, there are many steps that might be taken to accomplish this important national priority. However, the options to reach this important goal come down to changing the formula around this federal/state initiative, focusing on the cost drivers that increase the costs of the program, and cutting the reimbursement to providers.
For the steps to change the formula around this federal/state initiative, listed below are some of the options that have been put forward.
1. Set a maximum budget for expenditures on Medicaid and automatically change the formula for state aid to reflect that maximum budget amount.
2. Reform or repeal the CLASS Act (Community Living Assistance Services and Supports Act).
3. Reduce the states’ administrative cost reimbursement. This will save $ .25 billion per year.
4. Eliminate state taxation on providers that is used to lower the state’s share of the overall Medicaid expenditures. This saves $5 billion per year.
For the steps to focus on the cost drivers that dramatically increase the cost of the program, listed below are some of the options that have been put forward.
1. Nursing home care is the major part of the Medicaid budget. To reduce this cost driver, implement the following:
a. Research into Alzheimer’s disease to prevent or ameliorate the consequences of this disease;
b. Funding for programs to keep the elderly in their homes including home care, home inspection, nutrition support, and exercise support;
c. Continued and increased tax support for those who purchase nursing home insurance.
2. Move the disabled into managed care programs from the regular Medicaid fee for service program.
3. Move low income seniors and the disabled that are eligible for both Medicare and Medicaid into Medicaid Managed Care Programs. This will save $1 billion per year.
4. Develop and implement a standard program for the monitoring and management of diabetic and heart problematic patients. Compare the results of that program as to patient condition and cost to the unmanaged patient.
5. Review the Medicaid database for other chronic conditions that are high cost drivers and put together similar standards for monitoring and management.
6. Expedite Medicaid waivers to states for innovative approaches to reducing healthcare expenditures.
7. Reform medical malpractice. This will save $2 billion per year.
For the steps to cut the reimbursement to providers, listed below are some of the options that have been put forward.
1. Set a maximum budget for the expenditures on Medicaid and automatically reset prices for providers either retrospectively or prospectively.
2. Introduce another procedure code for physicians and their staff for monthly monitoring and management of chronically ill patients especially in the areas of diabetes and heart conditions. These 2 areas alone constitute major expenditure categories for Medicaid yet no provider has the funding to monitor and manage the care of these patients.
3. Migrate to capitation for provider payments using the Accountable Care Organization scheme.