Medicaid Reform Task Force

On March 20th the National Governors Association (NGA) announced the members of a Medicaid Reform Task Force. The members of this Task Force are US state Governors and although they have not taken a position yet, their contributions are likely to have a significant impact on US Medicaid Policy. 

Medicaid is the nation’s health care program for low-income and disabled individuals; it also underwrites the long-term care nationwide. In Colorado, for example, about half of the Medicaid long-term care funding goes to home and community based services that help people with disabilities stay out of expensive institutions. The other half is spent on nursing homes and institutional long-term care.

In Tennessee however, over three quarters of Medicaid long-term care funding is directed to facilities and nursing homes. The home healthcare system in Tennessee is not geared toward getting inappropriately institutionalized people out of nursing homes so in many instances the nursing home dominates disabled people’s lives. Most Tennesseans do not have a realistic option to live in their own home, and receive services in the most expensive and least desirable setting.

The most progressive statement the Task Force could make would be to demand the elimination the institutional bias in Medicaid and Medicare that robs millions of Americans of their most basic freedoms, dignity and independence daily. Governor Phil Bredesen of Tennessee is not on the Task Force, but still must direct the state away from the unfair long-term care system that favors expensive institutions over citizen’s desires. 

NGA's Medicaid reform principles, adopted last month at its Winter Meeting. They include:

• The Medicare and Medicaid programs are interrelated and any change made to Medicare, whether to strengthen its solvency, address its financing, or for other purposes, should be considered in conjunction with reforms to Medicaid.
• The federal government should assume full responsibility for the acute, primary, long-term, and pharmaceutical care of the dual eligibles, individuals who are enrolled in the Medicare program, but because of their low-income, are also eligible for the Medicaid program.
• It is also unacceptable for Medicaid to be the only long-term care program in this country. Other sources of coverage, whether federal, employer-based, personal, familial, or community-based, must be developed.
• States must have greater ability to manage the Medicaid program with respect to eligibility, benefits, cost-sharing, and coordination with private sector insurance.
• Medicaid reform proposals that provide states broader Medicaid program authority should weigh fiscal and health policy implications of the current financing structure, or an alternative approach.
• Efforts to reduce fraud and abuse by Medicaid beneficiaries and providers are essential to safeguarding limited health care resources, but any effort to develop error rates to measure state performance should be strongly opposed.
• To the extent possible, all current waivers should be replaced with clear statutory authority.
• The federal government should pay 100 percent of the cost of any new Medicaid mandates imposed under an act of Congress, federal regulation, or court decision based on federal laws and regulations.
• The federal cap on the commonwealths and territories should be removed and a federal contribution for commonwealths and territories should be implemented that is comparable to that of the states.

- Tim Wheat