These Two States Cut Medicaid…And Saved Money

Townhall.com ^ | November 29, 2014 | Matt Vespa

[Kaslin]

In 2012, the Department of Health and Human Services estimated that 72.2 million Americans were receiving Medicaid benefits for at least a month. Medicaid is a government health insurance program aimed at helping the poor and disabled.

Enrollment into the program is going up dramatically, according to the Institute for Policy Innovation (IPI). Both Medicaid and Children’s Health Insurance Program (CHIP) are up 15 percent, or 8.7 million people, since Obamacare began enrolling people in the fall of 2013; states that expanded Medicaid coverage are seeing 22 percent growth or more.

For many states, Medicaid is the largest item of their budget. Total Medicaid spending in 2012 was $432 billion dollars, with the federal government providing $250 billion; states are responsible for the rest.

This image courtesy of IPI

Illinois and Pennsylvania were the two case studies the IPI used to illustrate Medicaid reform:

As Illinois entered its 2013 fiscal year, the Medicaid budget faced a shortfall of $2.7 billion. The state had begun implementing some of the reforms that other states are incorporating, such as shifting more Medicaid recipients into private sector Medicaid managed care organizations (MCOs), but it needed to find even more savings.

In response, Illinois state Representative Patti Bellock garnered bipartisan support to pass the SMART Act in 2012, which included several Medicaid reforms. One of the most important of those was a provision to establish the Illinois Medicaid Redetermination Program (IMRP) to "redetermine" if Medicaid enrollees were still eligible to participate.

…

And it did just that. Maximus recommended removing 249,912 cases by the end of February 2014, according to the state.5 By law a state employee has to review the recommendations and decide if cancellation is appropriate. The state removed 148,283 cases (representing 234,000 individuals) from the Medicaid rolls.

However, the American Federation of State, County and Municipal Employees (AFSCME) filed suit claiming that most of the work should be done by state bureaucrats, and a federal judge agreed. Although the outside vendor is still involved, it’s role has been reduced significantly. Even so, the state has continued to identify people who should be dropped from the Medicaid rolls. According to state data, 173,469 Medicaid cases have been cancelled between February and September.6

Not all of these cancellations are the result of fraud. Many simply did not respond to the state’s repeated inquiries.

…

And the Illinois audit found that more than 8,000 dead people were still on the state’s Medicaid rolls.

As for Pennsylvania [emphasis mine]:

The Keystone State also cut its rolls, but with a somewhat different approach. After introducing several Medicaid cost-saving measures as Rhode Island’s secretary of Health and Human Services, Gary Alexander went to Pennsylvania as secretary of the Department of Public Welfare to tackle both Medicaid and welfare.

In July 2011, the Pennsylvania legislature passed broad legislation intended to weed out waste, fraud and abuse in the state’s welfare system to get welfare spending under control. Rather than turning to an outside group, Alexander hired someone to manage his Enterprise Wide Program Integrity Initiative to ensure that people on the welfare rolls, including Medicaid, were actually eligible for the program. Within 18 months some 220,000 people were removed from the welfare rolls, saving the state about $710 million, according to Alexander.

IPI noted that states are required by law to conduct audits of their Medicaid programs, but rarely do people get removed from the rolls.

[goldstategop]

I think its good in principle.

Medicaid provides affordable health care to low income Americans but it can be more efficiently managed at less cost to taxpayers while delivering quality medical care and improved patient satisfaction.

People say its our version of Canada Medicare - in that its true its publicly financed but health care is privately delivered. The state finances the entire cost and patients never see a bill.

[Bernard]

And the Illinois audit found that more than 8,000 dead people were still on the state’s Medicaid rolls.

While dead people still vote in Chicago, I was not aware that dead people continue to receive medical attention as well. Being on the roll is not the same as getting benefits. Or at least it is not supposed to be.....

[goldstategop]

I mean.... purging the dead off government rolls isn’t easy.

When my father died, I had to close his Social Security account and stop his benefit checks from coming.

But not many people are as diligent as me. So the system will have some fraud.

[RWB Patriot]

“Medicaid is a government health insurance program aimed at helping the poor and disabled.”

No, it’s a government racketeering scheme that steals people’s money without their consent under the guise of helping them pay their medical bills. The problem is that the people paying into it have no real say in when they get to use it.

[goldstategop]

Its progressive. Those who can’t pay... they get covered.

I’ve made the point often just by expanding Medicaid, we could have fixed the uninsured crisis in this country without inconveniencing the 95% that was always insured.

And such an expansion would have had bipartisan support. But the Democrats decided what the rest of America had wasn’t good enough and they took a giant wrecking ball to it.

The funny thing about Medicaid is enrolling in it requires no hassle, no navigating through confusing websites, comparing plan levels, options and prices and no extensive paperwork to fill out or premiums to pay. And enrollment is open year around.

Its everything Obamacare should have been but wasn’t.

[Principled]

And the Illinois audit found that more than 8,000 dead people were still on the state’s Medicaid rolls.

My question too. If the recipient were dead, were the checks cashed? If not, no money was wasted. However if the checks were cashed by someone pretending to be the dead person, why aren't people going to jail?

[Principled]

I’ve made the point often just by expanding Medicaid, we could have fixed the uninsured crisis in this country without inconveniencing the 95% that was always insured.

Gasp! The "uninsured crisis" you mention is just like the "global warming crisis"... no "there" there.

Further, why would anyone think that expanding a government program - an entitlement even - would ever do anything except make the problem worse?!

Better medical care via better insurance coverage will come from LESS government, not more. Remove regulations that prevent individuals from using health savings accounts as they see fit, remove regulations that prevent insurance companies from competing across state lines, etc ad nauseum.

[dennisw]

And the Illinois audit found that more than 8,000 dead people were still on the state’s Medicaid rolls.
While dead people still vote in Chicago, I was not aware that dead people continue to receive medical attention as well. Being on the roll is not the same as getting benefits. Or at least it is not supposed to be...

I figure half these dead peoples Medicaid cards are used by living relatives to get Medicaid/medical services....meaning fraud.

[goldstategop]

We have no true free market for the middle class and the affluent.

The current enrollment window is closing in two months. If you need to buy health insurance, tough luck.

You’ll have to wait til next fall.

Now its true some people couldn’t afford to buy any health care plan because of low income, pre-existing conditions or whatever. Medicaid is a sensible program. A modest expansion would solved the accessibility problem for many people.

But the Democrats chose many more people than needed help to mess up and that’s why they got screwed over and had their political behinds handed to them. If you’re going to embark upon a social reform, be sure sure it doesn’t result in more political losers than in political winners.

Obamacare simply doesn’t work.

[Chewbarkah]

Interesting article — thanks for posting. I wish you would rethink your application of the term “affordable”. From the perspective of welfare recipients, all handouts are “affordable”. $1 billion/day cash payments for each person? Quite affordable from the recipients’ viewpoint. But Illinois and PA are fine examples of states that are bankrupt. Is a vast expansion of Medicaid or any other net spending increase “affordable” for the taxpayers? The “savings” that the article discusses are actually just reductions in an enormous spending increase by bankrupt governments.

[goldstategop]

When we’re talking about waste in government there is plenty of it. Low income beneficiaries are not the problem.

There is a staggering amount of administrative waste, lax fiscal controls, no account of how and where money is spent and questionable expenditures.

Those are things we need to do to get spending under control and get government to do better the things it should do.

Unfortunately a lot of people resist common sense reforms. We need accountable and effective government in this country.

[Lorianne]

There is are still bureaucratic costs to dead people being on the rolls. I imagine that just the mailing out of information to dead people would cost a bundles and you know the government sends out multiple and mailings about every little thing and if they don’t receive a response they keep mailing more things.

[bert]

——meaning fraud-—

sub heading “Drugs, Oxycodone”

[wita]

I think there is room for improvement on both points.

My definition:

Mediacaid is a government program that takes tax money from the producers in this country, who have no say in the matter, and gives it away to the medical community in the various states to serve those supposed poor, disabled, and elderly who ostensibly cannot pay for their health care.

Definitions provided by others:

InvestorWords

A program, funded by the federal and state governments, which pays for medical care for those who can’t afford it. The program typically helps low-income individuals or families, as well as elderly or disabled individuals. To receive Medicaid, an individual must meet certain requirements (such as income level), and also must go through an application process. Although all states participate in the Medicaid program, each state manages their own program, and is able to set different requirements and other guidelines.

Investopedia:

DEFINITION OF ‘MEDICAID’
A joint federal and state program that helps low-income individuals or families pay for the costs associated with long-term medical and custodial care, provided they qualify. Although largely funded by the federal government, Medicaid is run by the state where coverage may vary.

Dictionary.com:

a U.S. government program, financed by federal, state, and local funds, of hospitalization and medical insurance for persons of all ages within certain income limits.

The bottom line of course is Government at the Federal level has no mandate in the Constitution to take from the haves to give to the assumed have nots other than some democrat congressman’s desire to have everyone feeling good about themselves having helped the poor, not out of altruism, but through outright theft by government.

[goldstategop]

We assume social insurance is good for the welfare of society.

Every civilized society provides for its least fortunate. It defines who are we are.

It separates us from the barbarians of the past and today who say today nothing we do makes a difference.

We’re better off because of it and God asks us to do it as an ethical obligation and not because we feel like being generous.

[bert]

for the record....

how do we know that the barbarians didn’t care for their own?

[goldstategop]

Like what the Romans did to the Christians in the arena? Or what Muslim savages today do to people who so much as look at them the wrong way?

I don’t want us to be like them. We are humane and decent because that’s who we are. There are the better angels our nature within us.

That’s exactly why we’re appalled and outraged at Ferguson. God is not offended by someone in want.

God is offended by someone who does evil and shows others no mercy.

[RWB Patriot]

Anything done without someone’s consent, with a gun offered as the sole reason one can do it, can’t claim to be good. The moral is the chosen, not the forced.

[Smokin' Joe]

Either that, or some outfit kept billing for services they were not providing.