For members of Gov. Andrew Cuomo”™s Medicaid Transition Team, the goal to trim $2.85 billion from the $53 billion a year program appears to need more than a few weeks to tweak.
“When the group selected for Commission on Health Care Facilities in the 21st Century was formed, people said it would be an impossible task to finish in 19 months. In this case, we have just a few weeks to come up with answers,” said Stephen Berger, who chaired that commission and is on the Medicaid Transition Team.
Daniel Sisto, president of the Healthcare Association of New York, is another of the 25-member team charged with the task of finding ways to cut costs to the program before Cuomo presents his budget to the Legislature on April 1.
Of the $53 billion New York pays for its Medicaid program, Sisto said approximately 17 percent of those receiving Medicaid use more than 75 percent of the money spent. Nursing home patients and the homeless, substance abusers and the mentally ill population, who have multiple chronic diseases comprise the bulk of that number.
“In some cases, the patient”™s history is so complex, it is difficult to treat and is not coordinated as it should be. Each condition is treated as a distinct episode, with no single entity responsible for the care of that person once they leave the provider,” Sisto said. “If we could better manage the care for that one group, we could save significant amounts of money and help the system overall,” he said.
The small percentage of patients driving up Medicaid so dramatically must be the primary target for saving money, he said, “but it calls for the health care system to reorganize itself to perform in a way it was not constructed to perform, which includes providing housing, social workers and rehabilitation centers as a core part of the solution.”
Another boondoggle for the Medicaid Redesign Team is stemming the flow of those who find way to protect the wealth of seniors who need the health services Medicaid provides ”“ and achieve a way to receive care without making any financial contribution.
“Such things as ”˜spousal refusal ”“ where the spouse takes the assets in their name, and then refuses to contribute to the cost of their spouse”™s care ”“ is often used as a way of getting the person into the Medicaid program without touching assets. The state can look back five years into how money was given away as ”˜gifts,”™ but if it needed for home care, it”™s an entirely different scenario, one where assets can be transferred the day before the person applies. What Medicaid has become to most is a long-term care insurance program, when it was originally intended to help the needy,” Sisto said.
“Medicaid was not designed as an ”˜entitlement”™ program, but to many, that”™s what it”™s become,” Berger said. “I don”™t know the ”˜short”™ answer. We were asked to come up with ideas that were less draconian to meet the short-term goal of balancing the 2011-2012 budget. Our next step will be to come up with long-term suggestions to reshape the state”™s health care system to bring down costs and make it better in the process.”
“While the federal government has time to learn as they go, the state must balance its books by April 1,” Sisto said. “And for every dollar we cut from the state program, we lose more than a dollar from the federal government. “We may cut Medicaid $2.85 billion, but the state will lose $6 billion. It”™s a challenge, to be sure.
“Should we fall short of meeting the governor”™s goal,” he said, “the commissioner of health would implement the cuts proposed. Our anxiety is the time frame: it is an incredible transformation to happen in just a few short weeks.”
Ironically, Sisto said, the drugs and treatments that have extended life expectancy may have helped people live longer, but they now tend to die from multiple chronic diseases rather than one acute episode. The combination of ailments later in life is quite costly to treat. “The goal, is to provide preventative procedures while people are healthy ”“ not wait until the person becomes ill.”
“Hopefully, the suggestions we make to Governor Cuomo in the first step will help us in our second effort,” Berger said. “We must also look at how other states have made their programs more manageable. For example, New York needs malpractice reform. Doctors are running defense, providing unnecessary procedures and ordering unnecessary tests to avoid litigation, which is also driving the cost of Medicaid up. There are many things that can be done, and must be done, but this is just the beginning of the process.
“We can do some things that would bring immediate financial relief to the state without causing harm; one is rewriting the drug formulary and putting a lot of the expensive drugs in their generic form and requiring doctors to specify they want the brand name drugs. Drug companies have been able to block this in the Legislature up to now,” Berger said.
“The governor wants our team to come up with ideas on how to provide care for less expense,” Sisto said. “If we have $3 billion worth of ideas, we don”™t have to make cuts. Everything is on the table when you have numbers that large. Mr. Cuomo has caught the mood of the people and has said there will be no more taxes ”“ we, as a team, are going to provide alternatives, hoping there are enough of them to minimize the damage.”
