Possible changes (for Medicaid): co-pays, new rules on assets
By Robert Tanner
The Associated Press
The nation's governors, weighing how to join in the federal debate on changes to Medicaid, are considering taking aim at the common practice of seniors giving away their assets so the government pays for nursing-home care. They also may demand that the poor pay a greater share of their health-care bills.
Those proposals — along with more consumer-friendly recommendations such as tax credits for long-term-care insurance — are being circulated among the governors in a 12-page document, a working draft of a statement that could be taken to Congress and the Bush administration.
The state-federal health-care program for the poor has grown faster than inflation and is estimated to cost more than $300 billion this year. It will serve roughly 53 million people.
Medicaid pays for two of every three nursing-home patients in the country. It pays for one out of three births. It has become the leading payer of mental-health services, and the leading payer of services for people with HIV and AIDS. One out of nine people in the country are on Medicaid.
Governors have not yet agreed on the recommendations and it's unclear yet whether a majority will, according to interviews with governors, state Medicaid officials, aides and health-care professionals who have been involved in or apprised of the discussions and seen the draft document.
Governors involved say they hope to save money through efficiencies such as electronic medical records and state purchasing pools, as well as other changes that could add costs to Medicaid beneficiaries or providers, or deny services to some people.
Reaching agreement has been elusive. The talks began in January, before President Bush proposed cutting Medicaid spending growth by an estimated $40 billion over 10 years. Governors united to oppose cuts, but they haven't publicly gone further on other ways to save money.
"We're three steps forward and four steps back," said Arkansas Gov. Mike Huckabee, a Republican who, along with Democrat Mark Warner of Virginia, is leading the effort.
The House budget would cut $20 billion over five years; the Senate refused any cuts but called for a study commission. Governors hope to take part in the federal debate but are leery of proposing changes that might be used to simply save dollars rather than improve the system.
"There's deep concern that Congress and the administration will come up with a number that they should save, and it will drive policy. And it should be the other way around," said Iowa Gov. Tom Vilsack, a Democrat.
Among the proposals:
• Adding deductibles or co-pays for medical care for Medicaid recipients, forcing patients to share costs and discouraging misuse of the system.
• Making it more difficult for senior citizens to transfer their assets to relatives or others so that they fall within Medicaid eligibility requirements. One proposal would allow states to examine a person's finances at greater depth in the interest of seeking repayment for government-provided care.
• Trying to find ways to discourage businesses from dropping health insurance or otherwise shifting employees to Medicaid, possibly through tax credits.
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