People are being forced into nursing homes because that’s what Medicaid covers - even if it’s not what they need.
That’s among the findings of the Governor’s Medicaid Reform Advisory Council, which will present a package of proposed reforms to Gov. Phil Batt on Thursday.
The reform proposals focus on ways of caring for Medicaid recipients short of institutions. The package, which also includes changes ranging from moving toward managed care to narrowing who’s eligible for pregnancy and delivery coverage, could save Idaho’s Medicaid program $12 million a year, council members estimate.
“Last year we were spending a million dollars a day on Medicaid,” said Sen. Gordon Crow, R-Hayden, vice-chairman of the council.
The bills have skyrocketed in recent years, although Idaho’s economy has boomed and unemployment has stabilized or dropped.
Part of the problem is the costly focus on nursing homes and other institutions. Idaho also offers “personal care services,” or help with such tasks as bathing and grooming. But there’s nothing between the two extremes.
At 35 hearings across the state, patients, relatives and others told the council they’d rather have care in their homes or communities than turn to nursing homes.
“If given the choice, they’ll almost always choose the least restrictive, least costly level of care,” Crow said. “That’s not only money-saving, it’s compassionate.”
The Medicaid program is funded 30 percent by the state and 70 percent by the federal government. It covers medical care for the poor and disabled. The program also provides coverage for pregnant women and children whose income is less than 130 percent of the federal poverty level.
In 1995, Medicaid paid for 37 percent of all the births in Idaho. The council would like to tighten eligibility by including the income of parents for a minor mother, and by counting the father’s income for an adult mother even if the two aren’t living together. However, those changes would require congressional action.
The council also proposed that all Idaho colleges and universities be required to offer pregnancy coverage for students and their dependents, and that students be required to have this insurance to enroll. That could be done through state legislation.
Another proposal in the package would provide “transitional” coverage to those who want to go to work, but are afraid of losing their medical benefits. Fees would be on a sliding scale.
The plan also calls for moving Medicaid toward managed-care strategies, such as requiring patients to go through a family doctor who acts as a “gatekeeper” before they can go to an emergency room or a specialist.
Idaho already is trying those tactics in parts of the state, through its “Healthy Connections” program. Benewah County is the first in the state to enroll all its Medicaid patients in the program.
One wrinkle in that program came up when Indian Health Services doctors weren’t included as gatekeepers. The council wants them included.
The package of reforms also includes numerous proposals aimed at eliminating duplication and discarding programs that make little sense.
“A lot of the programs are, like, if I had a leg amputated, the federal government or state government would send someone around every year to make sure my leg hadn’t grown back,” Crow said. “They’re that ridiculous.”
The council also recommended aggressively cracking down on fraud, and simplifying and tightening all eligibility rules.
Just as it did on welfare reform, Congress could enact legislation this year giving states more authority over how they run their Medicaid programs. The changes also could mean cuts in federal funding.
Through a series of waivers from federal rules, new state laws, and recommendations for changes in federal laws or rules, the council tried to envision a Medicaid system that would work better.
“We’ve got kind of a patchwork of statutes and programs,” said Kathleen Allyn, deputy administrator of Medicaid for the state. “The governor’s council is saying, let’s step back and see if it can’t be better coordinated - a more rational system of care that makes more sense.”
Batt will decide how much of the reform package he wants to pursue. When he followed a similar path with his advisory council on welfare reform, he ended up pursuing nearly the entire package of recommended reforms.
, DataTimes MEMO: This sidebar appeared with the story: MEDICAID IN IDAHO Medicaid costs in Idaho are skyrocketing, from $113 million in 1989 to $367 million in fiscal year 1996. This year, Medicaid is serving 84,339 Idahoans, up from 33,100 in 1989. Of those, 3,823 are in long-term care facilities like nursing homes. Out of this year’s $367 million budget, $113.4 million went to pay for those in the long-term care facilities. That’s nearly a third of the budget. Medicaid paid for 6,608 Idaho births in 1995, 37 percent of the births in the state that year. In North Idaho, the figure was 40.6 percent.