Competing for Medicaid Access, What a Mess


Where has $45 million of our tax dollars gone?

In the Wall Street Journal was a very interesting article identifying a problem that conservatives anticipated prior to the implementation of Medicaid expansion. The per capita increase in spending nationwide on the Medicaid expansion population patients is 16% higher over the past 3 years than on the traditional Medicaid patients.

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After all is said and done, and whatever model a State chooses to reallocate transfer payments direct payments to carriers or using the carrier as a plan manager, providers and carriers are incentivized to preferentially service those in the 90/10 the gap group, as opposed to those that Medicaid was originally supposed to help 70/30 group. Traditional Medicaid patients are competing for access to providers with the gap group.

We need to have another discussion about the difference between appropriated and allocated funding at the Federal level. When the cost of borrowing at the Federal level goes up interest rates go up, the matching formula for Medicaid in both groups will change placing an ever-increasing burden on State Budgets and ultimately on taxpayers. The MIPS Merit Incentive Payment System the so-called “value-based reimbursement system” for hospitals and doctors falls right into this scheme.

The SHIP of $45 million going to infrastructure to support MIPS, billing, QA Data programs is also a cost that we originally were told would only be for 5 years, but now seems to be ongoing. We need an audit of the SHIP program. Where has $45 million gone? What is our return on that investment? Has all the money been spent? How has the SHIP program impacted the number of patients in our State that have improved access to health care? Has the cost of coverage of those patients decreased, or has provider margins simply improved because the cost of building infrastructure to support a payment system simply subsidized the bottom line?

Providers are incentivized not to take care of sick patients like those on traditional Medicaid because length of stays and complications will be higher in this group and subsequent reimbursements will be impacted negatively. We paid $45 million to incentivize providers to take care of well patients in preference to those on the margin who through no fault of their own and who have chronic diseases cannot take care of themselves.

This is not benevolent charity, but purposeful exploitation of the vulnerable. But then patients don’t have special interests and lobbyists like the IMA/IHA/IACI looking after interests

I went into medicine to take care of sick patients—not make money taking care of young healthy patients. Cost before coverage, Coverage is not access, Access is not quality.

The State Health Insurance Plan that received $45 million dollars from the Feds to be given directly to providers to build billing and QA platforms to implement “value-based” reimbursements using MIPS—Merit Incentive Payment System. There has never been an audit of SHIP.

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