TOPSHAM — Maine legislators have an opportunity to improve the quality of life for many Mainers and potentially save the taxpayers money.

This double-header does not occur very often, but it is for real. By extending eligibility for Medicaid, as many other states have done, and by implementing a new way to pay health care providers, again as many other states have done, legislators can rightly take credit for doing the right thing for this state. The future of Medicaid in Maine (also known as MaineCare) is to be decided very soon.

One of the options under consideration by the Legislature is paying private insurers to provide managed care plans for MaineCare enrollees. Managed care is widespread in the health insurance industry and has the potential to provide a more efficient Medicaid, making it less costly while improving the quality of health care.

Managed care is not a new idea, so lawmakers would have plenty of reliable data to inform their debate of the proposal.

Most states, including Maine, have traditionally paid Medicaid providers, such as physicians, hospitals and nursing homes, using a fee-for-service payment system. Under this system, states have difficulty in predicting and controlling Medicaid spending. People eligible for Medicaid frequently have difficulty locating a provider who will take care of them. Health care providers frequently are not paid, which the recent problem in paying hospitals for care has shown. The growing cost of Medicaid is a key problem for states, including Maine.

To solve these problems, many states have implemented managed care plans, which are a different method of paying health care providers while improving access to health care services. Under the method, Medicaid-eligible people obtain medical care through an insurer under contract with the state. The state pays the organization a set amount per person per month to take responsibility for providing comprehensive services and covering most of the costs of providing medical care. Many employers who offer health insurance to their workers offer managed care as an option, so it has plenty of history.


Under Medicaid policy, the state can make these managed care plans optional for enrollees. But the state can make enrollment in managed care mandatory for everyone or even certain groups. The concept is already working for Mainers over 65 who select Medicare Advantage plans. They are simply managed care plans for Medicare eligible people who choose them.

What is the evidence about these managed care plans? Would MaineCare and the taxpayers benefit from utilizing these plans and replacing the current system, either completely or in part? These are key questions as the Maine Legislature considers changes in MaineCare.

The current, published evidence on Medicaid managed care plans concludes that these plans can reduce overall Medicaid program costs while providing better patient outcomes. For example, a study in 24 states with Medicaid managed care plan found that all states studied experienced a reduction in per beneficiary spending due to Medicaid managed care.

Our eyes must be open to the challenges of change. There is no guarantee these reductions will automatically occur if the Legislature approves a MaineCare implementation of managed care. There is no question that the implementation is complex. But we should not be afraid of change if it offers the potential for improvement.

To be sure, there are no easy solutions to the likelihood of increasing Medicaid expenditures. At the same time, there are also no easy solutions to improving the quality of care and to helping all citizens achieve an improved health status. Yet, now is the time to consider the implementation of positive change. If not now, then the Legislature must take responsibility for standing still.

Each state has options and decisions as to how they will cope with the projected trends and objectives under Medicaid. Maine has choices and the Legislature must make these choices. The choices seem to boil down to an opportunity to make a difference for Mainers or to stay in neutral.

While there are concerns about any change from the status quo, the evidence on managed care plans points to the potential for a more efficient and effective MaineCare.

– Special to the Telegram

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