Reforming State Medicaid

New York State Department of Health Commissioner Richard Daines and State Medicaid Director Deborah Bachrach are trekking throughout the state promoting their Medicaid reform agenda, which still needs to be passed in the Senate and the Assembly. On Wednesday, Bachrach addressed the Medicaid Matters coalition. On Thursday she met with the AIDS Advisory Council, while Daines addressed health care professionals in Plattsburgh.

“We have to have the right amount [of money] going out in the right way,” Bachrach said at Wednesday’s meeting.

New York State spends a whole lot of money on Medicaid for limited results. New York is ranked first among states in Medicaid spending per capita, but with comparatively paltry results in quality of care. New York also ranks 27th among the number of uninsured residents. For Bachrach’s full presentation, see this powerpoint.

Here’s a breakdown of some of the key points:

Fixing reimbursement rates

• One reason New York isn’t getting bang for its buck is that current Medicaid reimbursement rates are complicated and don’t provide incentives for efficient care.

• Hospital reimbursement rates use a nonsensical structure for payments, including billing yearly for costs it only incurs once. The DOH’s plan will change the reimbursement rate to more accurately reflect the actual cost of treating patients on Medicaid, paying more to physicians and outpatient clinics and less for bloated inpatient rates.

• 90 percent of $847 million in funding that was supposed to go towards hospital indigent care pools—caring for people with medical emergencies without insurance—instead goes to general hospital funds. The State wants to redirect that money to its intended purpose and also transfer $55 million of those state dollars to community health clinics, where poor people are likely to go.

Increasing access

• The State is working to eliminate barriers for who can receive Medicaid, such as the face-to-face interview—which is difficult for working people to make time for—and finger imaging. Finger imaging is a controversial measure meant to cut down on Medicaid fraud. However, the program—only mandatory for adults that don’t receive SSI—has only saved the State $84,000 in six years.

• The State is applying for a federal waiver to expand Family Health Plus to 200 percent of families’ incomes.

• The state wants to allow people aged 19 to 29 to stay on their parents’ insurance plans regardless of if they are in college.

“It’s a well thought out plan and acknowledges the mistakes of the past,” said Housing Works Vice President of New York Advocacy and Public Policy terri smith-caronia, who attended the Bachrach meetings with the Medicaid Matters Coalition and the AIDS Advisory Council. “We don’t have an endless stream of funding, and these plans address a way to right-size the payments in order to improve the quality of care the State provides.”

Medicaid is of special concern to AIDS advocates, since $2.3 billion of the $46.3 billion state Medicaid budget is spent on 60,000 to 70,000 poor people with AIDS.

Posted on January 29, 2009 at 5:08 pm

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