Tennessee Becomes a Laboratory of Radical Medicaid Reform

It's often said that our federal system of government allows states wide latitude to experiment with ways to make government more efficient or just work better. There are numerous examples where pilot programs begun at the state level end up being adopted by Washington.

But such experimentation has never been tried on Medicaid reforms. Medicaid is run by the states but every state is reimbursed a certain amount by Washington for every program beneficiary. It's a program that cries out for drastic reforms.

The Medicaid program is racked with incompetence and corruption. Just last year, it was discovered in an audit that the state of Illinois spent $4.6 million on paying Medicaid benefits to dead people. Back in 2013, the state in another audit discovered that nearly half of all Medicaid beneficiaries enrolled were actually ineligible to receive benefits.

Now the Trump administration wants to reform Medicaid not be tweaking the program here and there, but by radical surgery.

The Hill:

“There’s an aggressive point of view in CMS [Centers for Medicare and Medicaid Services] leadership which wants to do things with Medicaid. One of them was work requirements, but it hasn’t gone so well," Miller continued. "Another way is to do some sort of ... block grants.”

The administration is currently reviewing a plan from Tennessee to convert Medicaid into a block grant, a proposal that, if approved, could be the first in the nation.
Imposing block grants in Medicaid has long been a major conservative goal, and with time running down in President Trump’s first term, the administration is facing pressure to approve a plan advocates argue may not be legal without congressional approval.

There is going to be corruption...I would say state corruption will cost us less....

Maybe, maybe not. A local doctor was caught defrauding Medicaid millions of dollars. If there is a large pile of money anywhere, there are going to be people who want to ‘wet their beaks’ with it. A lot of people if there is a lot of money involved.

Even in small government units like municipalities there’s enough money available for theft. Some small city in California (Bell?) that has thieves getting rich.

Fair question and I don’t have an answer. Hundred of thousands of parasites sucking taxpayer money or thousands at the richer pickings of federal corruption. At least on the federal level the punishment, if caught, will come at the hands of federal courts instead of local state courts/prosecutors.

That said I have no problem with the Feds letting states try new ideas but realize that some states are going to try things that neither of us would like. California for example wants to extend MediCal (Cal’s Medicaid) to any human living in the state regardless of immigration status and expect the Feds to pick up the bill. When my mom was dying in California, MediCal had nothing to help her. Her Social Security check put her over the income limit.

There is going to be corruption...I would say state corruption will cost us less....
Maybe, maybe not.

Currently, state bureaucrats think only of how to get the 90-10 split. Depending on the way a program is designed and pitched, it could be 100% state funded. Or 50-50, or 70-30, or 90-10 or many other ratios. The goal of every bureaucrat is to get 90-10, which means doing what pleases the Federal bureaucrats.

What is good for the Medicaid recipient is a distant 2nd.
What is good for the medical provider is 3rd. What is good for the taxpayer is last.

If #1 is removed from the equation, what would the new split be in driving decisions?

One of the problems is that the quality of government databases is far worse than that of private firms. A State Farm or Allstate would never allow the number of errors that are in a Medicaid database. The markeplace, the customers, would never allow the error rate.

One problem in fixing the error rate is the lawyers. If I don’t attempt to fix the errors, then the errors are treated as an act of God, an act for which no human is responsible. But if I try to fix 100 errors and fix only 99, the person involve in that 1 out of 100 can sue the pants off of me.. and my boss.... and the state.

This is the same problem hospitals and medical providers have... fear of lawyers.

One of the first fixes that is needed in each state, and federally, is some logic and public interest in the tort law system.

I check our bills against services, 1 idiot PA was to stupid to file her bill on time despite having copies of ins cards, past 6 Months Tricare Life could care less and won’t pay it, she sent it to a collection agency. By the time Tricare Life and Medicare had explained the rules, she had to eat the rather large bill.

Checking my first check up with new PCP he’d added a NOT needed or asked for test HIV OPPS was all he said. That 1 I let go past, hubby’s Primary did the same to him. Medicare is pushing this test on Seniors. We have never lived that life style that would lead to a case of HIV.

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