March 20, 2013

LePage seeks more federal funds for Medicaid

Maine says it will take part in wider eligibility if the Obama administration picks up the costs for 10 years.

By Steve Mistler
State House Bureau

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"We would need to provide for our current populations under a more flexible structure, like a global waiver. This would provide us with the independence that is necessary to make holistic changes to our Medicaid program that would best serve Medicaid populations," Mayhew wrote.

Mayhew's reference to a "global waiver" could become a point of contention.

The federal government typically mandates specific Medicaid coverage criteria in exchange for providing funding to states. States can petition the government for waivers that give them more discretion to manage their Medicaid programs.

A global waiver can be more expansive than a traditional waiver. Several states have requested global waivers, including New Jersey, Vermont and Rhode Island.

Rhode Island's waiver, granted in the final weeks of the Bush administration in 2009, has been championed by conservative organizations, including the Heritage Foundation, for achieving savings in the state's Medicaid budget.

Rhode Island's global waiver is sometimes compared to a Medicaid block grant that essentially allows states to take federal dollars and manage their Medicaid programs and cap spending.

Skeptics have challenged the purported savings, arguing that Rhode Island has spent less on Medicaid because of increased federal reimbursement rates and additional dollars from the American Recovery and Reinvestment Act.

Mayhew declined to provide specifics Wednesday about the administration's vision for a global waiver. But she said the state needs greater flexibility to better manage its Medicaid recipients and associated costs.

In her letter to Sebelius, Mayhew wrote that the state "must reinvent our Medicaid program through innovations that ensure a patient-centered approach and hold providers and payers accountable for quality outcomes."

In a telephone interview, Mayhew cited the fact that Medicaid funding can't be used for home-based care for some elderly people.

The result, she said, is a "perverse incentive" to push patients into nursing homes, a more expensive service, but one that Medicaid covers.

The state could apply for a narrow waiver to change that scenario, but Mayhew said that process could take years.

She said she is convinced that the Obama administration is "interested in exploring any and all options" and "good-faith negotiations" that will lead states to participate in Medicaid expansion.

The state recently won a $33 million Medicaid innovation grant from the federal government, a fact that Mayhew cited in her letter to Sebelius.

Steve Mistler can be contacted at 620-7016 or at:

On Twitter: @stevemistler

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