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By SUSAN M. COVER
Staff Writer 10/03/2007

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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