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Tuesday, Aug. 30, 2016

Begin with Medicaid in cutting expenses

Thursday, February 3, 2005

Missouri doesn't have a health care crisis, Missouri has a Medicaid crisis. With one million low-income Missourians receiving Medicaid benefits, the state is simply overwhelmed. Recipients are not checked annually to review their eligibility and it seems doubtful to me that the state has adequate manpower to make those mandated reviews each year. In short, Jefferson City we have a problem.

Instead of reducing benefits, the ideal solution would be for the state to begin a thorough review of all recipients to assure they are indeed eligible. But there should also be a massive crackdown on health care providers who provide unnecessary care and order unneeded testing for Medicaid recipients.

Both of these ideas - reviews and provider crackdown - are being suggested to hold the line on Medicaid expenses.

The state says that nearly 70 percent of Medicaid recipients had indeed had their cases reviewed although the latest audit puts that figure a bit lower. For example, the state already acknowledges that $1.3 million was paid last year for recipients who had passed the age of 19 and were no longer eligible. But that's just the beginning.

St. Louis Senator Maida Coleman, a Sikeston native, believes the bulk of fraud in Medicaid comes from providers overcharging and providing tests that are not necessary. And she has a very strong point. But it's going to be difficult to police the providers and to differ with them on the level of care that is necessary. Regardless of how difficult it may be, attention must be focused on the providers as well as the recipients.

The numbers in Missouri pose a problem. Each Social Service personnel assigned to handle a Medicaid review has on average 500 cases in his or her workload. That makes it virtually impossible to adequately screen and review each recipient. But the last thing we need is more social workers to add to the bureaucracy in Jefferson City.

It's obvious no one has a complete solution for our Medicaid crisis. But few other budget items are as large or are the source of potential fraud as the Medicaid program. If the state is genuinely interested in cutting spending and eliminating fraud, Medicaid is the logical starting point.

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