The nation’s governors, weighing what to tell Congress they want from Medicaid reform, may take aim at the common practice of seniors giving away their assets so the government pays for nursing home care. They could also demand that the poor pay a share – or a greater share – of their health-care bills.
Those proposals, along with more consumer-friendly recommendations such as tax credits for long-term care insurance, are being circulated among the governors in a 12-page document – a working draft of a statement that could be taken to Congress and the Bush administration. The idea is that the governors would have a united position in the debate over how to rein in soaring costs of the state-federal health-care program for the poor.
Governors have not yet agreed on the recommendations, and it’s unclear yet whether a majority will, according to interviews with governors, state Medicaid officials, aides and health-care professionals who have been involved in or apprised of the discussions and seen the draft document.
Governors involved emphasize they hope to balance money-savings through efficiencies such as electronic medical records and state purchasing pools with other changes that would add costs to Medicaid beneficiaries or providers, or deny some people services.
Reaching agreement has been elusive. The talks began in January, before President Bush proposed cutting Medicaid spending growth by an estimated $40 billion over 10 years. Governors united to oppose cuts, but they haven’t publicly gone further on other ways to save money.
“We’re three steps forward and four steps back,” said Arkansas Gov. Mike Huckabee, a Republican who, along with Democrat Mark Warner of Virginia, is leading the effort.
The basic problem, he said, is that every tweak in Medicaid would have a different effect in each state, causing more pain for some than others.
The House budget would cut $20 billion over five years; the Senate refused any cuts but called for a study commission.
Medicaid now pays for two of every three nursing home patients in the country. It pays for one out of three births. It has become the leading payer of mental health services, and of services for people with HIV and AIDS. One out of nine people in the country is on Medicaid.
