Medicaid Expansion and Reform/Separate the chaff from the wheat/Update

September 7, 2015, Implementation is upon us.  I repeat, going forward, I would like to see a citizen’s oversight panel tasked to monitor, verify, and report on the progress of Medicaid Expansion and Reform. The panel could serve like an ombudsman, a Complaint Department, for any individual, business, or provider that feels harmed by expansion.

Citizens must ensure their legislators ask the Department of Health and Social Services the right questions in order to evaluate its success.

We must stay involved, raise our collective voice, and trust — but verify.

 

 

The debate over whether or not to accept Medicaid Expansion and Reform is in my rear view mirror.For blog_me

Governor Walker announced he will do this under his last remaining option; the 45- day policy, used seven times since 1991 – last time was in 1998 (per LB&A).  His decision has been made; the train has left the station; it is happening.

Beyond the required political posturing, the huffing, the puffing, I doubt any elected state officials will formally challenge the governor’s decision – not if they want to get re-elected in 2016. Two polls commissioned last spring, and reported on by KTVA (http://www.ktva.com/polls-show-support-for-governor-and-medicaid-expansion-379/) showed strong public support for Medicaid Expansion among those polled.  I don’t think public sentiment has changed since then.

Another illustration of the current huffy puffy political climate are the fear tactics used by Senator Pete Kelly, Senate District A, Fairbanks. In his article (published in Alaska Dispatch News, July 24) Kelly, wanting to gain support for his position, leads with a lame attempt to coin a word similar to the broadly disliked (by conservative Alaska) Obamacare.

http://www.adn.com/article/20150724/sen-kelly-walkercare-supporters-skip-4-fatal-flaws-medicaid-expansion

“Total Medicaid spending exceeded $1.6 billion in FY 2015 and will grow to $2.8 billion by 2025 — even without expansion. Medicaid in its current form is unsustainable and is the biggest cost driver in state government. The governor should work for real reform instead of instituting Alaska’s version of “Walkercare,” which has the potential to sink the system we already have.”

 Pure bluster.

We must look forward at what is important and determine how we, the general public, can help the state get it right. We must separate the chaff from the wheat.

Common sense lies somewhere in the middle of the far-left or -right opinions, and the answers lie within the collective us.

Customer satisfaction, costs, services, and provider supply and demand are all tracks of a complex healthcare system that must be managed and continuously improved by the State Department of Health and Social Services (DH&SS) under the leadership of Governor Walker and Commissioner Valerie Davidson. No small challenge.

Medicaid Expansion and Reform will be overlaid into this already very large, complex, system; therefore, the discussion needs to be about its implementation, customer satisfaction, cost containment, and continuous improvement.

In my quest to understand what Expansion means to the State, I reached out to DH&SS Medicaid Expansion and Redesign Coordinator Chris Ashenbrenner.

Contrary to what expansion opponents are claiming, I’ve come to believe there was adequate time last session, and special sessions, for the program to be properly vetted.

According to Ashenbrenner, the Department testified at over 30 hearings and answered many questions from lawmakers. Those inquiries included questions about the payment system and the need for reform.

Ashenbrenner told me that currently more than 90 percent of payments are being made accurately and on time, and that reform work has already started.

“The department has reforms underway that are expected to result in $240 million in savings,” she said. “These reforms include Fraud & Abuse Control Initiatives, Pharmacy Reform Initiatives, and a Care Management Pilot Program for ‘Super Utilizers’ of the ER, Tribal Health System Coordination, and eligibility requirements for Personal Care Attendant Services. The Department recently awarded a contract for technical assistance to identify even more reform opportunities looking at best practices and innovations from across the country.”

Critics of expansion also talk about the need to delay, but expanding now is a better deal for Alaskans than waiting would be. The federal government will pay 100 percent of expansion costs through 2016, then 90 percent starting in 2020. The clock is already ticking.

Ashenbrenner said, “Every day Alaska has delayed in expanding Medicaid, our state lost out on $400,000 of new federal revenue and 42,000 Alaskans lost out on health care.”

I asked about the concern that Medicaid expansion would fund increased abortions in Alaska. “No,” Ashenbrenner said, “Expansion adds no new pregnant women to Medicaid – they are already covered under the Pregnant Women Medicaid. The Department contends, instead, that Medicaid expansion is expected to reduce abortions because so many more women will have full access to primary care and that includes family planning.”

But what if the debt-ridden federal government backs out of the promise to pay 90 percent of expansion costs beyond 2020?

Ashenbrenner said, “The Department’s position is that Alaska takes federal money for our roads and airports, at a 90% match which we are thankful to receive. We don’t question those funds. There is no reason to question federal funds that provide basic access to health care services for Alaskans.”

Besides, she reminded, me, it would take an act of Congress subject to presidential veto to change the reimbursement rate.

“If that were to happen,” Ashenbrenner said, “Governor Walker has stated that Alaska would end the coverage.  The U.S. Secretary of Health and Human Services, Sylvia Burwell, wrote a letter to Governor Walker validating that states are not required by the federal government to continue the coverage.”

In addition, she assured me that Medicaid expansion would not supplant the federal government’s responsibility to fully fund Indian Health Services: “Medicaid Expansion is a way the federal government helps tribal health care providers. They (Indian Health Services) continue to pay at 100 percent for all services provided their beneficiaries at tribal facilities, even after the expansion federal match transitions to 90 percent.”

Many critics are concerned that Medicaid Expansion costs will make the current fiscal dilemma worse and could potentially escalate to consume as much as one half of state’s budget.

Ashenbrenner said that DHSS testified that the reforms currently planned by the state will save $240 million over the next six years.

She said, “The savings Medicaid expansion brings to the health care system is a catalyst for health care reforms that are planned both by providers and the state.”

Ashenbrenner told me that other Medicaid reform planning is underway with the help of local and national experts, and that reform initiatives identified will be presented to the Legislature in January.

Fellow Alaskans, it boils down to trust.  Last November, a majority of voters placed its collective trust in the hands of Gov. Bill Walker and Lt Gov. Byron Mallott, and one of their ticket’s earliest campaign issues was to expand Medicaid in Alaska. I remain confident in the administration because the truth is – only time will tell us if Expansion will succeed in Alaska.

Going forward, I would like to see a citizen’s oversight panel tasked to monitor, verify, and report on the progress of Medicaid Expansion and Reform. The panel could serve like an ombudsman, a Complaint Department, for any individual, business, or provider that feels harmed by expansion.

Citizens must ensure their legislators ask the Department of Health and Social Services the right questions in order to evaluate its success.

We must stay involved, raise our collective voice, and trust — but verify.

Sincerely,

LeadDog Alaska

©Medicaid Expansion 2015

 

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