Medicare and Medicaid: Two venerable government assistance programs designed to help individuals that would otherwise have trouble paying their medical bills. This, however, is where the similarities between the two end. Through provisions in healthcare reform, funding for the federal Medicare program will be slashed, while Medicaid, which is administered by each state, is slated for expansion.
The government’s intent to broaden and fund state Medicaid programs to encompass greater numbers of needy individuals is rooted in good intention. Many observers, however, are questioning the rationale behind a wholesale expansion of Medicaid and states are expressing concern about their ability to administer a significantly larger program in light of budget cuts and shortfalls.
The industry also is collectively wondering where the capacity to treat millions of additional patients will come from, given the difficulties that those already enrolled often have in locating a doctor to treat them. “Since Medicaid reimburses doctors significantly below the cost of providing care, more and more doctors are being forced to turn patients away,” according to a New York Times article published in 2010 on Medicaid expansion risks.
But perhaps the greatest issue that Medicaid expansion has brought to light is the fact that even though individuals are eligible for government assistance, many, for whatever reason, are not enrolled in the program. According to a study published in the New England Journal of Medicine, only about 62 percent of eligible individuals are actually enrolled in Medicaid.
Problems with Medicaid expansion are likely to arise when the program changes to include all adults with a family income of 133 percent of the federal poverty level. According to the NEJM report, this nation-wide change “belies the tremendous heterogeneity among the 50 state Medicaid programs, which vary in terms of enrollment procedures, demographics of the target population and state politics.”
Additionally, there is a concern that expansion will not be an equitable undertaking. Highlighting this concern are statistics showing the wide variances in participation from state to state: Less than 44 percent of eligible residents in Oklahoma, Oregon and Florida are enrolled in Medicaid, compared with 80 percent in Massachusetts and 88 percent in Washington, D.C.
The article, “Medicaid Expansion—The Soft Underbelly of Health Care Reform?” published in the New England Journal of Medicine, concludes that these variances “will complicate any attempt to implement such a broad expansion and cast serious doubt on the precision of predictions about its outcome.” The article predicts that in order to enroll the estimated 16 million additional people by 2019, states will need a substantial increase in participation from those already eligible in addition to the newly eligible.
It appears that simply expanding a somewhat broken system will only lead to greater problems in access and quality. With three years left before expansion is slated to occur, there is still time to fix several issues plaguing the Medicare program. One such fix would be for states to evaluate current Medicaid enrollment procedures to streamline and facilitate participation by beneficiaries. States that have fallen behind in this area may be well-served to look to those with high enrollment rates as examples of success.
Before expansion takes place, the healthcare community must jointly strive for policies and technologies that help providers screen patients for eligibility in Medicaid or other coverage programs. More often than not, assistance is available if individuals know where to look.
Kim Williams serves as the senior vice president of operations at Chamberlin Edmonds, an Emdeon Company.