Medicaid reform


Medicaid Overhaul Must Focus on Long-Term Care

Over at Roll Call I have a column about what Congressional Republicans rightly seeking Medicaid reform can do to deal with the challenge of managing the long-term care component of the program.

Today, states try to manage long-term-care costs and quality through regulations and supply controls, but these efforts are never a match for the cost pressures that build when services are “free” to the users — and when rising use of services increases the incomes of those providing the services.

The solution is to enlist the support of those enrolled in the program in a cost discipline effort. The starting point is to calibrate financial assistance for long-term-care services and supports to the level of disability and financial needs of a Medicaid applicant. The most severely disabled applicants — as determined by an independent evaluator — with the lowest level of personal resources should get the maximum “allotment,” set at the level necessary to cover the range of support services needed to stay in the community. Other applicants with lesser disabilities or more personal financial resources would get a percentage of the maximum allotment commensurate with their circumstances.

You can read the rest of the piece here.

posted by James C. Capretta | 6:11 pm
Tags: Medicaid reform, long-term care
File As: Health Care

Federal Grant Funding is Key to Medicaid Reform in Texas

Arlene Wohlgemuth and I have an op-ed in this weekend’s edition of the Houston Chronicle on why federal block grants are the right way forward for Medicaid reform in Texas.

On both the acute and long-term care side of Medicaid, the program suffers from the same problems as the broader health system. Third-party insurance - in this case public insurance, poorly managed by the federal and state governments - creates distance between those providing care and those receiving it.

With the freedom that a block grant would afford, the state could use Medicaid funds to offer a version of "premium support," and subsidize the purchase of private insurance for non-disabled, non-elderly enrollees, who could choose an insurance plan from a competitive field. It is through this kind of competition that costs can be held in check.

You can read the rest of the piece online here, and those interested can look at our more detailed proposal on Medicaid reform in Texas here.

posted by James C. Capretta | 3:25 pm
Tags: Medicaid reform
File As: Health Care

End Medicaidís Crony Federalism

Over at National Review Online I have a column on why Republican governors should resist the Obama administration’s Medicaid expansion, and instead seek real legislative Medicaid reform.

The GOP governors engaged in these direct negotiations with the White House are playing a loser’s game, and throwing away a historic opportunity to secure fundamental and lasting reform of the Medicaid program. Even if individual states are able to secure concessions from HHS and the White House, the “deals” they strike will be in the form of temporary and inconsequential “waivers” (the terms of which will always be subject to administration amendment and revision, too). What’s worse, these deals are no way to run a national program. Why should one state receive more favorable treatment than others? And why should the administration be allowed to “buy off” states with federal taxpayer funds in the first place?

Instead, GOP governors should withdraw from this White House game of “let’s make a deal” and instead decide, as a group, what kind of Medicaid reform to demand in return for considering broader insurance coverage. Importantly, the reforms they seek should be in the form of legislative revisions of Medicaid, not temporary “waivers.” By pursuing a legislative approach, the GOP governors could join forces with House speaker John Boehner and Energy and Commerce Committee chairman Fred Upton, who have made serious Medicaid reform one of their top priorities this year.

You can read the rest of the article online here.

posted by James C. Capretta | 1:01 pm
Tags: Medicaid reform
File As: Health Care

More on Medicaid Reform in Texas

In December last year, the Texas Public Policy Foundation released a report that I co-authored with colleagues from Leavitt Partners.  The report focused on how the state of Texas should reform the long-term care components of the program to stay within the confines of a fixed Medicaid budget, such as would be the case with a block grant.

This week, TPPF released a follow-on report outlining the broader reform strategy for the Medicaid program.  The report describes in some detail the provisions which should be included in federal legislation to convert Medicaid into a block grant.  It then also describes what the state of Texas should do once it gets a block grant to provide more cost-effective services to its citizens.  In short, the report provides a roadmap for making a Medicaid block grant work at both the federal and state levels of government and should be of interest to state policymakers in all fifty states.

The full report is available online here, and the pdf version is available here.

posted by James C. Capretta | 12:04 pm
Tags: Medicaid reform
File As: Health Care