Legislators Gain Insights into Medicaid
By Marina Byrd, CSG Graduate Fellow
Why not federalize Medicaid?
The question was theoretical, but Robert Kerr, South Carolina’s former Medicaid Director, gave attendees at The Council of State Governments’ Medicaid Policy Academy in June something to think about.
Kerr preceded the question with another: “Why do we think it is a better operation to have one class of care for Medicaid recipients than we are willing to have for ourselves?”
Medicaid enrollees are confined to one state for care, whereas those not on Medicaid can transcend state borders for specific care, he said.
In addition, he said, Medicaid directors must decide which recipients can go to other states for treatment. That decision, he said, is often limited to children and really odd scenarios.
His idea of a federalized program is one where states could pay into a federalized system on a per capita basis to allow patients to have seamless care between borders.
Kerr was just one of the speakers at the second CSG Medicaid Policy Academy, aimed at giving the 45 state legislators from 30 states and one U.S. territory who attended the opportunity to share ideas about best practices for the federal/state health care program.
Speakers challenged attendees to think outside the box when it comes to Medicaid.
For instance, Darin Gordon, TennCare director and deputy commissioner for Tennessee’s Department of Finance and Administration, walked participants through lessons learned from two decades of managed care.
Tennessee was the first state to enroll its entire population in managed care. Gordon said the state opened the program Jan. 1, 1994. In just six months, it went from 800,000 enrollees to about 1.2 million enrollees. He predicts states expanding Medicaid under the Affordable Care Act will have similar rapid growth in enrollment.
Gordon offered Tennessee’s experience as a lesson for Medicaid agencies in their states. His suggestions included:
You get what you pay for. To have a strong program, states need to invest in and train the right people.
Numbers matter. Legislators need to help the agency build a strong data infrastructure.
“It is a partnership.” Even though the managed care company signs a contract, the state still owns risk. When the plan fails, it is the state’s responsibility.
Have an objective view of what is going on. Use an independent external review.
Make sure cost estimates are realistic and “align financial incentives across the program as a whole. Don’t look at it in the silos that exist.”
Virginia Delegate John O’Bannon was recently appointed to a Medicaid study commission in his state and was particularly interested in Gordon’s presentation.
“We’ll be looking into Tennessee's long-term care approach as we look at this in Virginia,” he said.
Dr. Leighton Ku, a professor and the director of Center for Health Policy Research at George Washington University, provided practical information for policymakers. He reviewed his research on the Massachusetts smoking cessation efforts and its almost immediate savings of $3 in hospital spending on heart disease for each $1 spent on cessation program.
Attendees said it isn’t often that they hear about a program that reaps almost immediate savings versus a vague promise of down-the-road savings.
Legislators were pleased with the information they gathered at the policy academy.
“Overall this is a must-do conference for legislators who are interested in the well being of the citizens in their states,” said North Carolina Rep. Carla Cunningham.
Massachusetts Rep. Keiko Orrall said the policy academy gave her new perspectives and insights into the direction of state Medicaid programs.
“It is clear that leadership is critical to the health of a state's Medicaid situation,” she said. “Each state is unique and the implementation of the Affordable Care Act is creating enormous challenges that can only be overcome by knowledgeable policymakers.”