Nationwide Medicaid Watch
Governors and state legislators have devised proposals for sweeping changes in Medicaid to curb its rapid growth and save billions of dollars.
Under the proposals, some beneficiaries would have to pay more for care, and states would have more latitude to limit the scope of services.
The proposals, drafted by separate working groups of governors and state legislators, provide guidance to Congress, which 10 days ago endorsed a budget blueprint that would cut projected Medicaid spending by $10 billion over the next five years.
Many of the proposals resemble ideas advanced by President Bush as part of his 2006 budget. In some cases, the governors embrace Mr. Bush's proposals but go further. At the same time, they also reject some of the president's recommendations that they believe would shift costs to the states.
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State officials generally support Mr. Bush's proposal to limit the ability of elderly people to qualify for Medicaid coverage of nursing home care by transferring assets to their children. The governors say such restrictions "should be encouraged," because "Medicaid can no longer be the financing mechanism for the nation's long-term-care costs." Medicaid now pays for about two-thirds of nursing home residents.
Mr. Hurson, the president of the conference of state legislatures, who is also chairman of the health committee in the Maryland House, said, "Medicaid was never intended to be a middle-class entitlement program for nursing home care."
State legislators have discussed a proposal to give states a fixed amount of federal money for long-term care, a sort of block grant that would automatically be increased each year to keep pace with medical costs and demographic changes. State officials would have broad discretion to use the money for nursing homes and home health care, but individuals would not have an entitlement to such services.
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Governors seek "broad discretion" to set premiums, co-payments and deductibles, subject to certain limits. Congress, they say, could establish "financial protections to ensure that beneficiaries would not be required to pay more than 5 percent of total family income."
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State officials also want to change what they see as one of the most onerous requirements of the Medicaid law. Under this provision, states must treat any health problems discovered in periodic examinations of children under the age of 21. About half of the states have been successfully sued under this provision.
The National Conference of State Legislatures says Congress should "provide more flexibility for states" to limit this benefit.
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Governors also want Congress to make it easier for them to persuade federal courts to set aside orders relating to their Medicaid programs.
Note especially that last one. I assume this refers to legislation, like that currently pending in Congress, that would essentially overturn Frew v. Hawkins.