10:00 am CST - December 27, 2010
Posted under The Scoop
States are desperate to control costs. What works & what doesn’t?
Texas Insider Report: AUSTIN, Texas – Medicaid covers 48 million poor Americans with health insurance for children & non-disabled adults, and coverage for the disabled & long-term care. But states differ in who, what & how much is covered. California spends $969 per adult enrollee (2007) versus $5,108 in Alaska, and $3,473 per elderly person in Arizona versus $21,507 in Connecticut.
No excuses: Tennessee, Rhode Island and Florida have shown how costs can be contained.
States would jump at a proposal to allow more flexibility in Medicaid, though many will groan at any suggestion to cap the program’s open-ended federal matching grants.
We have reason to believe this suggestion will work.
Two years ago Rhode Island got a Medicaid waiver giving it more flexibility, while capping the federal government’s share of the costs. The state claims its efforts have saved $150 million in 18 months.
Florida has been a Medicaid reform leader for the disabled. Its “Cash and Counseling” program, which gives disabled people personal assistance accounts to choose their own caregivers, has been very popular.
And more than a dozen states have adopted the program.
Long-term care can provide significant savings if states crack down on eligibility. With more flexibility, states could lower the home equity that can be exempted — up to $750,000 in some states — and require a reverse mortgage before Medicaid will pay for a nursing home.
As for health insurance, Gov. Phil Bredesen of Tennessee ended the state’s extensive TennCare program, replacing it with CoverTN, which provides only basic coverage, including physician visits, preventive care and generic drugs at very low out-of-pocket costs. While the coverage is capped at $25,000 total annual benefits, it only costs about $1,800 a year.
If Congress adopts a system of capping the open-ended federal role, it will begin a new era for the program, and most of the talk of opting out of Medicaid will disappear.
Merrill Matthews is a resident scholar with the Institute for Policy Innovation in Dallas.