Last night, listening to John Kasich’s Ohio acceptance speech, and his call to bring leadership back to the states, reminded me of a recent blog by Washington health care consultant Bob Lasewski .
Kasich took advantage of the state’s ability to adjust how Medicaid is handled at the state level to control costs and expand coverage. A read of Lasewski’s blog will indicate, the value of a real team effort and hard work at the state level.
We can’t convey enough the importance of the attached article. John Kasich shows what real leadership looks like, and with hard work, and a willingness to work with others, that solutions can be made for the good of the people.
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Please review an excerpt of the article below, and as always, please let us know if we can be of help or answer any questions you may have.
Ohio Governor John Kasich’s Medicaid Expansion: Successful Governance Is Very Hard Work.
Let me suggest the real questions here are:
· What would we do with this class of chronically uninsured people who in their current economic circumstances have no hope of buying a private insurance policy or paying big deductibles and co-pays?
· What would the most cost efficient program look like for them?
· How would Medicaid become an efficient and sustainable platform over the long-term?
If we are actually looking for solutions and not just reacting to the expansion of a welfare program, any welfare program, then Ohio’s Medicaid expansion holds some lessons as an impressive and enlightened experiment in public policy.
Ohio has enacted a series of Medicaid reforms–many under waivers from the Obama administration.
These reforms began with a jobs reform bill enacted in 2011 that:
· Linked nearly ten percent of nursing home reimbursement to quality,
· Increased access to cost-effective home and community based services,
· Freed local behavioral health from Medicaid match requirements,
· Consolidated health plan regions to be more efficient,
· Linked one percent of health plan payments to performance,
· Integrated Medicare and Medicaid benefits into one care delivery system, and
· Implemented a new Medicaid claims payment system.
Then in 2012, the Kasich administration:
· Implemented a new integrated eligibility system for Medicaid and all other programs that require income verification prior to receiving services,
· Accelerated the adoption of electronic health information exchange,
· Enhancing statewide data sharing through “agencies without walls” protocols,
· Protected individuals in home and community based services,
· Supported people with intellectual disabilities through the “Employment First,” program and
· Targeted regional “hot spots” in mental health service capacity.
In 2013, the Kasich administration expanded Medicaid management with programs that:
· Tightened Medicaid fraud and abuse protocols,
· Capped Medicaid managed care spending at 3% annual growth,
· Focused on reducing avoidable hospital readmissions,
· Assisted nursing facility residents with mental illness willing to move to home care,
· Increased provider rates for home and community based services,
· Committed Ohio to spend 50 percent of its Medicaid long-term care budget on home and community services (vs. 43 percent in 2013),
· Created a new cabinet-level Ohio Department of Medicaid, and
· Consolidated mental health and addiction services in a single agency.
Then in 2014, the Kasich administration:
· Created a new Office of Human Services Innovation,
· Converted Ohio veterans on Medicaid to the federal benefits they earned, with first
· Gave priority to veterans residing in nursing homes,
· Invested $50 million to rebuild community behavioral health system capacity, and
· Automated background checks to protect vulnerable Ohioans.
And, for the 2016-2017 budget, the Kasich administration initiated a series of reforms projected to hold Medicaid spending growth to 2.5% in 2017. They have also gone to the Obama administration requesting a waiver to implement Health Savings Accounts in the Ohio Medicaid program.
The Kasich administration’s latest reforms include steps that:
· Hold per member per month cost growth below three percent over two years,
· Preserves Medicaid coverage for children and pregnant women up to 200 percent of poverty and everyone else up to 138 percent of poverty,
· Invested $286 million over two years to increase opportunities for Ohioans with developmental disabilities to live and work in the community,
· Modernized Medicaid mental health and substance abuse benefits and improving care coordination through managed behavioral health care,
· Moved additional populations into care coordination,
· Increased affordable housing to avoid unnecessary institutional placements,
· Targeted resources to reduce infant mortality in the most at-risk neighborhoods,
· Speeded up the transition off of Medicaid and requiring the Ohio Department of Medicaid to seek a federal waiver to implement Health Savings Accounts,
· Transitioned all income-tested programs to the Ohio Benefits eligibility system,
· Replaced Ohio’s two duplicate disability determination systems with one,
· Reduced potentially preventable hospital re-admissions, and
· Expanded the Medicaid in Schools Program to cover more services for children with special needs.
If Governor Kasich and his health care team have proved one thing in recent years it is that successful governance is very hard work. Just think of what they could do if the states had even more flexibility and they didn’t have to go begging the federal government for permission to modernize their Medicaid program?
Malcolm & Stacey Cutler
Malcolm Cutler, Jr. CLU
CUTLER INSURANCE SERVICES
15901 Hawthorne Blvd., Suite 200
Lawndale, CA 90260