Lawmakers criticize Medicaid changes

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August 18, 2010

By RONNIE ELLIS CNHI The Glasgow Daily Times Wed Aug 18, 2010, 12:41 PM CDT

FRANKFORT — State lawmakers are looking for ways to hold down Medicaid costs just as first the recession and soon health care reform will add to its rolls. But the Medicaid Cost Containment Task Force was more interested Tuesday in criticizing Washington.

The task force heard from Donna Folkemer, with the National Conference of State Legislators, who discussed what other states are doing to prepare for additions to Medicaid rolls as those who earn 133 percent of the federal poverty level are added to its rolls when the health care legislation is fully enacted. According to Rep. Jimmie Lee, D-Elizabethtown, that would mean adding another 300,000 Kentuckians to Medicaid which already serves about 800,000 of the state’s poor and disabled.

But Lee also is unhappy that Congress expects states to implement the new health care legislation without a lot of information or guidelines. He said it will be difficult for the task force to offer recommendations on how to restrain the costs of Medicaid “when there are so many unknowns out there, not only for next year but for the year after that.”

Senate President David Williams, R-Burkesville, quizzed Folkemer about the increased enrollment under the health care bill while Sen. Julie Denton, R-Louisville, called for measures to reduce Medicaid clients’ overuse of emergency rooms. Sen. Tom Buford, R-Nicholasville, asked about ways to hold down fraud and abuse in the system.

House Speaker Greg Stumbo, D-Prestonsburg, asked Folkemer about other states’ use of private contractors to deliver some or all Medicaid services. Stumbo, during the previous General Assembly session, sought information from the Cabinet for Health and Family Services on costs associated with Passport, a private, managed care program operated in Jefferson County and about 14 surrounding counties.

Stumbo complained again Tuesday that lawmakers had difficulty getting information from the Cabinet, noting the cabinet said expanding Passport would not save the state money while not providing data to back up that claim.

“The challenge for lawmakers is to better understand Medicaid,” Stumbo said later, conceding he’s not an expert on the issue. “There are a handful of legislators who have a very good understanding, but we need a better understanding for the rest of us.”

He said the Passport program pays physicians flat fees to provide health care – rather than a fee for service which encourages unnecessary visits and he wants an analysis of the program to see if it can be expanded or replicated in other parts of the state. He said there are ways as well to cut down on prescription drug costs and to reduce over billing.

Folkemer said most states are looking at a variety of ways to reduce costs: reducing or freezing provider payments; limiting benefits to clients; limiting prescription drug costs; higher client co-payments; expanding managed care programs; and elimination of some benefits.

Stumbo said after the meeting that what he’s heard so far is “somewhat enlightening,” but the issues under discussion aren’t really new or different from those discussed for years as Medicaid costs have risen.

“I haven’t heard any solutions,” Stumbo said. “Why haven’t there been more complete analyses of what’s working and what isn’t?”

Ronnie Ellis writes for CNHI News Service and is based in Frankfort. Reach him at rellis@cnhi.com. Follow CNHI News Service stories on Twitter at www.twitter.com/cnhifrankfort.

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