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Published: Tuesday, 4/19/2011

Medicaid surgery

Gov. John Kasich’s administration has useful ideas for operating Ohio’s Medicaid program more cost-effectively. But while the need to reduce spending in the health-care program for poor and disabled Ohioans is beyond dispute, the administration’s cost-cutting measures cannot become excuses for denying care to patients who genuinely need it.

Medicaid serves 2.2 million Ohioans, about one of every five residents. It is the single largest item in the state budget — more than $18 billion a year. Although federal aid now pays for almost two-thirds of Ohio’s Medicaid spending, such support will drop as stimulus funding expires. So Mr. Kasich is surely correct when he says the state must get Medicaid costs under control.

In a recent essay in The Blade, Ohio Medicaid director John McCarthy noted that some 173,000 Ohioans who need long-term care account for 7 percent of Medicaid enrollment, but 41 percent of the program’s spending. Per-person spending on nursing-home care is 52 percent higher in Ohio than the national average, the Kasich administration says.

That is an argument, state officials say, for moving patients whenever possible from nursing homes to less-expensive home and community settings. Why, then, does Governor Kasich’s proposed budget cut funding for the PASSPORT program, which is designed to do just that — even as the state expects the program’s caseload to rise?

Greg Moody, who heads Ohio’s new Office of Health Transformation, told The Blade’s editorial board the state will trim costs of long-term care by doing a better job of coordinating services for patients who are eligible for both Medicaid and Medicare, which serves elderly people.

He says the state’s Area Offices on Aging, which administer PASSPORT services locally, also could operate more efficiently. He cites wide variations in program spending across the state.

PASSPORT “costs have been rising faster than caseloads,” Mr. Moody says. “We need to change that dynamic.”

But leaders of area offices on aging, in northwest Ohio and elsewhere, warn that the governor’s budget would mean less care and longer waiting lists for PASSPORT clients. That, they say, would force more people into, not out of, nursing homes.

At the same time, leaders of Ohio nursing-home lobbies argue that the governor’s budget would cut state payments to skilled nursing facilities in a way that would deny appropriate institutional care to many patients who cannot be cared for adequately at home.

There is an obvious degree of economic self-interest in such pronouncements. But it surely would be as much a false economy to reduce basic care for patients who aren’t able to go home as to shortchange a home-centered program the state says it wants to encourage.

The nursing-home groups have proposals for rewarding facilities that improve the quality of institutional care, as well as those that reduce its cost. These ideas deserve to be part of the budget debate in Columbus.

The proposed state budget also would reduce Medicaid payments to hospitals and other providers. Such a course is necessary, but the state must take care not to drive payment rates so low that providers simply stop treating Medicaid clients.

The Kasich administration is on firmer ground when it seeks to reform Medicaid by promoting better options in home health care for people with chronic illnesses, to keep them out of hospitals. It seeks to apply the same model to disabled children on Medicaid rolls by working with Ohio children’s hospitals to create pediatric managed-care programs.

In all cases, “transformation” must not become a euphemism for cutting Medicaid spending to the extent that vital care is threatened for Ohio’s neediest people. That is not reform, but regression.



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