Medicaid reforms compared
Maine lawmakers are given overview on states' efforts
By SUSAN M. COVER
Staff Writer
Kennebec Journal & Morning Sentinel 10/03/2007

AUGUSTA -- Charging co-pays for services or requiring recipients to pledge a more health-conscious lifestyle are two ways states are looking to cut their Medicaid spending, a national health-care expert told Maine lawmakers Tuesday.

Laura Tobler, a health policy expert with the National Conference of State Legislatures, gave an overview of Medicaid reform across the country to the Legislature's Health and Human Services Committee on Tuesday, as the state grapples with the $2 billion it costs annually to treat more than a quarter million children and poor and disabled people.

Medicaid is the largest health program in the country, covering 62 million people.

"There's a big focus on chronic disease management," she said. "Health-care costs are concentrated in sick people."

The sickest 10 percent of Americans account for 64 percent of the expenses, she said. That's why many states, including Maine, have focused efforts on helping people avoid illnesses linked to smoking, drinking and overeating.

"Many of the diseases we suffer from are related to self-inflicted choices," she said.

Two years ago, the federal government relaxed restrictions on state Medicaid programs to allow them to make changes more easily, she said.

And though experts predicted a flood of changes would be made, only seven states have taken advantage of that option, she said.

A few examples:

n Kentucky created four benefit packages that can be "tailored to the health-care needs of the individual," she said. There are co-pays for some services and incentive programs for those who comply with a disease management program.

n West Virginia allows healthy adults to sign a Medicaid member agreement if they want "enhanced" benefits, or a lesser package for those who don't sign the agreement or fail to live up to its terms. The agreement includes language that says, "I will use the hospital emergency room only for emergencies."

n Idaho offers health savings accounts in which enrollees can earn credits for complying with recommended preventative services.

The credits can be used for things such as nicotine replacement therapies and gym memberships.

Maine has not made changes in response to the federal Deficit Reduction Act, but has taken other steps to save money within the state's Medicaid program, which is called MaineCare, Department of Health and Human Services Commissioner Brenda Harvey said.

Maine has increased pharmacy co-pays and is moving to a managed care model that sets standards of care for physicians and others, she said.

"Very few states are taking on major reform," she said, "and all those that are are in their infancy."

Rep. Lisa Miller, D-Somerville, said she's not anxious to implement more changes immediately until there are results from other states. She said Maine's move to a managed care system will be enough change in the short term.

For example, some states have shifted costs onto those who use the program, which has lowered enrollment.

She's not sure that's the route Maine wants to take.

"Some of the cost sharing things have implications," she said.

"You can save money because your classic Medicaid population won't sign up. Maine wants to save money by finding efficiencies."

Tobler said all states are watching to see what happens on the national level when it comes to major health-care reforms.

"The movement nationally is for states to have flexibility, but on the horizon are the presidential candidates and their platforms," she said.

Susan Cover -- 623-1056

scover@centralmaine.com

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Kayaker of Augusta, ME
Oct 3, 2007 6:46 PM
Maine cannot even afford to pay the providers. Are you aware that the individuals that work to get the claims paid and work with the members issues are NOT even Maine employees? They are contracted by a company out of Boston called "PCG", Public Consulting Group. They contract with local staffing agencies and provide temp jobs for people that have access to members files and information. Alot of this information is known by the reps on the phone taking those calls from angry doctors that want to get paid, but guess what? The wallet is empty. The reps see this on the computer system yet are told to tell the providers that they need to wait for their "check". What a scam. They are so in the hole it is unbelievable. They are so out of touch, get this, I have a friend that worked there and he told me they had an employee that did not show up to work for 3 days, ver out of the ordinary. The employer then called the individual and fired them via cell phone. Two weeks later the police show up at PCG on Sewell street and ask questions as the individual was found dead in their apartment and had been dead for 2 weeks. How horrible. Nice to know that the state has such a laxed take on this and that they outsource to a Boston company and add to the secrets of having the reps tell providers there is money there when there really is not. How unethical!report abuse
Ann Gary of Gardiner, ME
Oct 3, 2007 1:24 PM
Sophie, if they can afford to buy cigarettes they can afford to pay for the patch or pill on their own. Patches for 2 weeks run $25-40.oo How much for cigarettes for 2 weeks? More then the patch or pill.report abuse
Wayne Ladner of Richmond, ME
Oct 3, 2007 12:58 PM
If Maine wants to cut costs and trips to the emergency room for non-emergencies they should help to create 'after hours' medical facilities.

Doctors routinely send patients to the emergency room for non-emergencies for hours other than 8AM-5PM Monday through Friday. This burdens EVERYONE involved; patients, ER staffing, hospitals, Medicare, and insurance companies alike.

Give Mainers an alternative in each community where they can go for non-urgent care, and costs will start coming down immediately.

Emergencies involve loss of blood, limbs, organ damage, severe pain, loss of consciousness, possible heart attacks and the like, i.e., if you're afraid the patient might die, THAT's an emergency.

Non-emergencies might be a broken finger, sprained ankle, double vision, bronchitis, sinus infection, 'road rash' from falling off a bike, etc.

Today patients feel they have no alternative if one of these events happens on a Friday night and their doctor doesn't open until 9AM Monday.

Have a place where local doctors as well as the person at the hospital ER can refer people for non-emergencies. Let the ER personnel deal with true emergencies, and not clutter up the waiting room with people who don't need it.

The cost to run an ER is huge compared to a an after hours medical office or outpatient clinic. Use the existing clinics and help to fund overtime pay if you want for needed personnel and leave the administrative staff home in bed.

If anyone in Maine is serious about lowering health care costs, this is an Excellent place to start, and again, EVERYONE benefits.

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Joe Morgan of Winthrop, ME
Oct 3, 2007 12:02 PM
I totally agree Sophie. Also, the MaineCare system should team up with the wellfare systems and not allow those on wellfare to purchase tobbacco products or alcohol if their on wellfare, period. It would decrease the use of the Mainecare system since it would decrease the negative medical effects that these products create which is on our buck. It would also be nice if MaineCare would pay for taxi rides to medical appointments, medical facilities or the ER for non-emergent issues. I can't tell you how many times i've heard "Mainecare will pay for an ambulance ride and not a taxi." Do you know how much an ambulance ride costs?!?! Alot more than a taxi ride! This would decrease the amount of ambulance calls, which would decrease the need for more staffing, which would decrease our taxes. So in the end we would save TWICE! It would also be nice if the Mainecare system would match benefits with community service for those who qualify. If you want so much in hand-outs, then you must work so many hours for the State. There are PLENTY of able-bodied people on Mainecare, for whatever reason, who can help themselves to a certain degree. I'm tired of paying for those who abuse the system when I work 80+ hours a week to pay my bills. AND birth control should be MANDATORY for those on wellfare or Mainecare since we're footing the bill. If you can't afford a family then you can't have a family! If we made it harder to qaualify for these services, we would have less people looking for a new career on our dollar. There should also be a residency requirement where you would have to have been living in the area for so long in order to qualify too. This would decrease people moving here just because the wellfare system is so good and easy to get, which in turn will decrease taxes. I do feel that there are people who do actually need help, but they are far and few between from my experiences. The people at the top of this list should be our Military Vets who need it!report abuse

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