Move to have businesses manage Medicaid is triggering concern

The Washington Post: Since Congress passed the health overhaul, businesses that manage Medicaid "are rushing to get a foothold in states that outsource Medicaid. … But the experience in some states suggests pitfalls ahead. A recent report found that 2.7 million children on Medicaid in nine states, most of them states that outsource Medicaid, are not receiving required screenings and immunizations. In Milwaukee, the two biggest provider networks in the city broke ties with [St. Louis-based insurer] Centene, and the state is overhauling its Medicaid contracts for southeast Wisconsin, dropping Centene from the mix. The complaint was that the insurer was creating profits at the expense of patient care, a charge the company denies." Some studies suggest that in some locations, managed Medicaid has slowed the cost increases without undermining care. "The theory is that insurers can save states money by reducing avoidable treatments. ... But managed Medicaid has also produced a steady stream of controversies" (MacGillis, 7/8). 

The Washington Post also includes a graphic about Medicaid expansion in states: "Under the new healthcare law, Medicaid will expand by at least 16 million people as eligibility is raised in 2014 to a new nationwide standard of 133 percent of the poverty level. The surge in enrollment will be highest in states in the South and West, where eligibility standards have been stringent" (7/8).

Meanwhile, Capitol News Connection gives a status report on legislation "to help states foot the bill for Medicaid health coverage for the needy" noting that it "is all but dead amid spending concerns. This despite desperate pleas from state governors." The federal government's share of Medicaid costs increased as a result of last year's stimulus package and the pending congressional proposal would have extended this additional federal funding until mid next year. It "was originally slated to cost $24 billion ... before Democratic leaders scaled it back an attempt to appease critics. It hasn't worked. … Last week, several governors came to Washington to lobby lawmakers in person in hopes of breaking the stalemate. They had more than a few allies but not yet enough votes" (Quinones, 7/7).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.