Congress grapples Medicaid reform

House yet to pass bill to cut $50 billion from social programs

COLUMBIA BASIN — Eighty percent of Grant Mental Healthcare clients are utilizing Medicaid to receive mental health services.

"If we don't take care of our people early, they're going to end up in more costly services," said Sharon Kiehn, director at GMHC.

Kiehn's concern comes at a time when members of Congress are considering significant cuts in Medicaid and other social programs for 2006.

The Medicaid cuts are part of a reform effort to curb the program's growing costs to state and federal governments. The reforms have also heated up debates as to who should qualify for Medicaid, how much they should pay and how much control states should have in providing Medicaid services.

Last week the House was expected to vote on a bill that would cut $50 billion in social programs, including Medicaid. That vote did not take place due to mounting dissension on the House floor and as of Thursday morning had not been decided.

According to an AP report, changes to the House bill were made Thursday to subdue moderates' concerns. A proposal to raise copayments from $3 to $5 for the poorest Medicaid beneficiaries and a proposition to deny free school lunches to 40,000 children whose parents would lose food stamps were dropped. Modifications were made to a proposal denying Medicaid nursing home benefits to individuals with home equity of $500,000. The cap has been raised to $750,000.

Medicaid is a program that pays for low-income individuals and families to receive medical assistance. The program became law in 1965 and is jointly funded by federal and state governments.

Today it has become the largest funding source for medical and health-related services for low-income families, affecting the amount of funding some states are able to spend on other programs such as education, corrections and transportation.

In a report from the Kaiser Family Foundation, total Medicaid spending in the nation for 2004 was $296 billion. Washington State ranked 16th out of the nation for its Medicaid expenditures of $5 billion.

Medicaid Assistance Admin-istration spokesman Jim Stevenson, said Washington State has been aggressively trying to reduce its Medicaid costs since the 2001-2003 biennium.

Efforts to do so have included offering the most cost-effective medications under health care plans and encouraging providers to stop prescribing treatments people want for personal comfort rather than medical necessity, Stevenson said.

Another concern Stevenson has is the cost of a new Medicaid computer system of which the Federal government has said it will pay 90 percent of the cost.

"If they go into that budget and say they're not going to pay, that hangs the state with a very big expense," Stevenson said.

Another issue revolving around the Medicaid debate is a change the Federal government made earlier this year that Medicaid dollars can no longer be used for non-Medicaid clients.

As a result, state legislators supported $82 million in back-fill monies to cover non-Medicaid clients who can no longer receive Medicaid dollars.

At a legislative discussion in October, Rep. Janea Holmquist, R-Moses Lake, said one of the main concerns she heard voiced from residents in the Basin is that now there is a sufficient amount of non-Medicaid dollars and not enough for Medicaid.

The pendulum is swinging back the other direction now, Holmquist said.

Holmquist predicts that additional non-Medicaid dollars that are not being utilized will be pooled to other areas in the state where they can be used.

Moving away from a government-controlled Medicaid program to one that gives more control to individuals is also being discussed at the local level.

"Instead of the government just paying for an individual's health care expenses, the individual would receive a stipend to purchase a health insurance plan in the private market and be responsible for managing their own health care dollars," said Rep. Bill Hinkle, R-Cle Elum. "This would not only provide Medicaid recipients with more choices, but would also provide incentives to make healthy lifestyle choices."