CT News Junkie | OP-ED | Medicaid Myths Challenged

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OP-ED | Medicaid Myths Challenged

by | Jul 30, 2015 10:00pm
() Comments | Commenting has expired
Posted to: Analysis, Health Care, Insurance, Opinion

As we celebrate the 50th anniversary of the legislation that created the Medicaid program, we would like to share some important facts about Connecticut HUSKY Health (Medicaid).

HUSKY Health is an essential component of our social service safety net that provides comprehensive medical, behavioral health, dental, and non-emergency medical transportation to beneficiaries in Connecticut.

HUSKY Health is also an important means of ensuring that beneficiaries are more economically secure and don’t have to face the catastrophic effects of being uninsured while facing major health events or managing long-term, chronic conditions.

From time to time, we encounter some misconceptions about this vital program. With that in mind, here are a few myths and facts that are good to know, especially as we commemorate President Lyndon B. Johnson’s historic signing of Medicaid (and Medicare) into law.

*  *  *

Myth: Only very poor people who don’t work use Medicaid.

The reality: Not true. Connecticut HUSKY Health (Medicaid) is currently serving nearly 750,000 people. That is more than 20 percent of the state population. Medicaid serves thousands and thousands of working people, including those who work for large companies, almost 100,000 older adults and people with disabilities who need long-term services and supports, and over 400,000 children and their caregivers.

Myth: Medicaid is not a good investment of public dollars.

The reality: Not true. Spending on Medicaid does represent a significant part of the state budget. But while the total cost of the program is close to $6 billion, it is important to know that 100 percent of the costs associated with the Affordable Care Act (ACA) eligibility expansion (in Connecticut, the HUSKY D eligibility category) are eligible for federal reimbursement, and the federal government covers 50 percent of all other covered Medicaid services (and 65 percent of the costs of services covered by the Children’s Health Insurance Program (CHIP, HUSKY B).  For Medicaid, this federal reimbursement results in a $2.5 billion state cost, representing 13.6 percent of the overall state budget.

Medicaid’s ‘cost’ also should be looked at in the context of preventing higher cost down the road.  For example, if an older adult is not treated for heart problems and diabetes, the medical costs will soar with more intensive care that could have been prevented.

We are also proud to show that even while we have seen significant increases in participation in Medicaid due to the ACA expansion, per member/per month (PMPM) spending in HUSKY Health is trending downward. We are not aware of any other Medicaid program that is seeing this result.

Further, Connecticut HUSKY Health has administrative costs (including all eligibility-related costs) of only 5.2 percent. HUSKY Health is a lean and efficiently-run program.

Myth: Medical providers don’t participate in Medicaid.

The reality: Not true. Currently, over 33,000 providers are enrolled in and provide services to HUSKY Health beneficiaries. Participation by providers is increasing over time.

In the biennial budget that was just enacted by the legislature, Gov. Dannel P. Malloy and the legislature agreed to continue to invest in additional resources to support Medicaid-enrolled primary care providers.

PCMH practices use tools such as extended hours, on-site care coordination, and electronic health records to better support their patients. Additionally, HUSKY Health contracts with four administrative services organizations (ASOs) that support beneficiaries in locating providers, either over the telephone or through web tools that show where providers are located and how to contact them.

Myth: Medicaid doesn’t help people get healthier.

The reality: Not true. HUSKY Health provides comprehensive benefits that can address the entirety of a person’s medical needs. Additionally, through its contracts with the ASOs, HUSKY Health uses a tool called predictive modeling to identify people with complex healthcare situations (e.g., frequent use of the emergency room, co-occurring medical and behavioral health conditions) and contacts them to offer Intensive Care Management (ICM) support.

ICM nurses and behavioral health staff start by identifying anything that might be a barrier between a beneficiary and his or her health goals (e.g., housing instability, food insecurity) and then works with the member to identify a range of supports to improve his or her wellness.

ICM has had a dramatic effect on the lives of those who have participated, and has saved millions of dollars.

Over calendar year 2014, ICM provided support to almost 12,000 Medicaid beneficiaries. Overall, use of the emergency department by those individuals declined by almost 36 percent and inpatient admissions were reduced by 51 percent. This resulted in a total savings of over $12 million.

Myth: Medicaid is only about medical care.

The reality: Not true. HUSKY Health supports the physical, behavioral, and dental health of its beneficiaries, and also supports their independence and participation in their communities.

Medicaid/HUSKY Health is all about the people we collectively serve throughout Connecticut — the health we protect and the lives we make better.

Kate McEvoy, Esq., is the Medicaid Director at the Connecticut Department of Social Services.

DISCLAIMER: The views, opinions, positions, or strategies expressed by the author are theirs alone, and do not necessarily reflect the views, opinions, or positions of CTNewsJunkie.com.

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Archived Comment

posted by: osemasterofdoom | August 3, 2015  3:43pm

osemasterofdoom

“it is important to know that 100 percent of the costs associated with the Affordable Care Act (ACA) eligibility expansion (in Connecticut, the HUSKY D eligibility category) are eligible for federal reimbursement, and the federal government covers 50 percent of all other covered Medicaid services (and 65 percent of the costs of services covered by the Children’s Health Insurance Program (CHIP, HUSKY B).”  Oh, good.  So instead of my state tax dollars going to pay for this, my federal tax dollars are paying for it.  How comforting.

From what I know about HUSKY, it is a well-run program.  However, I can’t tell if this state tax/federal tax shell game is done deliberately, or is just the basic mindset of people in state government.  I also don’t know which of those two possibilities is more frightening.