February 22, 2012

Maine Medicaid costs above U.S. average

The Associated Press

(Continued from page 1)

Former state Rep. Mike Saxl was among the legislators who pushed for increased Medicaid coverage of Maine children in 1996. That was followed in later years by additional measures to expand coverage to parents and childless adults and for prescription drugs for the elderly, he said.

At the time, expanding Medicaid was considered a smart move because every dollar in state funds leveraged at least $2 in federal money, he said. It was also viewed as a cost-saving measure since preventive medicine is cheaper than treating medical problems when they get to crisis stage, he said.

Medicaid is an important policy debate, but there are questions that deserve answers if the funding is going to be slashed, he said.

"How does somebody practically get coverage? Are we saying they want them to have uncompensated care at hospitals and doctor's offices? That's an option," he said. "Are we saying we want them to not have care? That's an option. Are we saying they should private insurance? That can be a good idea, but how are they going to afford that private insurance?"

Virtually every state over the years has expanded Medicaid coverage to some level beyond the core minimum requirements set by the federal government.

If Maine provided only the bare Medicaid coverage required by law, it would have just over 250,000 people on Medicaid rather than today's level of 360,000, state officials say.

But because of Medicaid's flexibility, the enrollment rates and costs are widely variable among states. While Maine provided some form of Medicaid coverage to 27.8 percent of residents in 2009, only 12.5 percent of New Hampshire residents were Medicaid recipients that same year. Maine and New Hampshire have roughly the same population, but Maine had about 200,000 more people on Medicaid than the Granite State.

California had the highest enrollment rate (30.2 percent), while Nevada had the lowest rate (10.9 percent), according to CMMS figures.

Generally speaking, most states through the years have broadened Medicaid coverage more for children than they have for adults, said Robin Rudowitz of the Kaiser Family Foundation in Washington. Maine has expanded coverage to adults more than most other states, she said.

But with the poor economy and revenue collections down, states the past couple of years have been implementing new Medicaid policies to cut spending.

The Kaiser Family Foundation said 47 states made cost-reduction Medicaid changes for fiscal year 2011.

For the current fiscal year, every state but North Dakota planned at least one policy change to contain Medicaid costs, Kaiser said last week in a midyear Medicaid budget update report. Forty-six states planned rate cuts or restrictions for health care providers and 18 states planned to reduce or restrict benefits. Four states, including Maine, planned eligibility reductions, but federal Medicaid officials have denied requests for enrollment procedure changes for Hawaii and Arizona.

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