Ideas for Reforming NYS Medicaid

[Linda_D]

Medicaid is a huge expense in NYS, impacting both the state budget and, especially, the county budgets. Even as long ago as 6-7 years ago, county execs from all over the state went to the Pataki administration begging for relief as Medicaid expenditures were then sucking up 100% of property tax revenues in virtually every upstate county and some wealthy downstate ones as well. Unfortunately, the response to that wasn't any kind of "reform" but a very modest shifting of costs to the state and cutting reimbursement rates.

I've included a link to a PDF that describes the Medicaid system here: Medicaid. Since Medicaid is a federal program, minimum standards for eligibility and services are required by the US government. That means that NYS cannot apply state residency restrictions, so that isn't really a viable "reform" proposal.

What I'd like to do is make this thread a "brainstorming" one in which posters come up with good ideas for reforming Medicaid. Once we created a good list, I volunteer to put them into a "letter" that MB members could copy and paste into email or snail mail docs to send to the governor-elect, state legislators, and to friends in different parts of the state so that they can forward the docs as well.

It's easy to say, "cut Medicaid!" but that's an amorphous idea that usually only results in reducing the rates the state allows to hospitals and doctors for services. That doesn't fix the problem but only creates financial problems for hospitals, especially those in small cities and towns (ie, outside of NYC, Buffalo, Albany, Syracuse, Rochester, Utica, Yonkers). It also restricts access to medical services as there are fewer physicians/physician groups that accept Medicaid patients. I think coming up with a list of concrete proposals is a much better way to go about reining in this program -- and doing it without simply dumping on poor people.

[Linda_D]

Here's my first idea for reforming Medicaid: require Medicaid providers/recipients to write/accept the use of generic drugs if they exist rather than brand name drugs.

This is what just about anybody who has prescription coverage in his/her medical insurance has to do these days. If there is no generic or the doctor chooses to write a name-brand prescription or the patient wants the name-brand, the insured person pays a larger co-pay. It seems to me that Medicaid recipients should follow this same rule.

If a generic exists, and the doctor or patient decide to use a brand-name drug instead of the generic, then charge the patient a token co-pay of $1-3. Even that small amount will convince patients to take generics if available.

[Riven37]

It is well known that generic drugs have little to no medical value, it more like taking a sugar pill. You want to deal with Medicaid in the right way, you will need to take away many of those liberal goodies the Medicaid people use like cab rides, Emergency rooms, dobubble dippers both the patient and doctors, and most importance is make Medicaid harder to get for new residence like making it a 5 year residency before you can receive Medicaid.

Here's my first idea for reforming Medicaid: require Medicaid providers/recipients to write/accept the use of generic drugs if they exist rather than brand name drugs.

This is what just about anybody who has prescription coverage in his/her medical insurance has to do these days. If there is no generic or the doctor chooses to write a name-brand prescription or the patient wants the name-brand, the insured person pays a larger co-pay. It seems to me that Medicaid recipients should follow this same rule.

If a generic exists, and the doctor or patient decide to use a brand-name drug instead of the generic, then charge the patient a token co-pay of $1-3. Even that small amount will convince patients to take generics if available.

[300miles]

It is well known that generic drugs have little to no medical value, it more like taking a sugar pill.

I think you are mistaken, Riv.

[Anotherview]

Implement a stringent program that will greatly reduce welfare fraud. The program would conduct searches on current recipients and new membership.

[anyones neighbor]

I think you are mistaken, Riv.

It would NOT be legal if that was the case.

[anyones neighbor]

OK here's MY story.
I always worked until I couldn't anymore. In 1994, I was paying my own Healthcare. When I quit working and went on Disability THEY paid my health insurance and in 1999 when I turned 62, I got Medicare. So I had Medicare, Health ins, and Medicaid. Now last April, SS decided to give me a widows pension, about $400 more than I was getting. Sounds great right? Last week I got a letter from Social Services that I had to pay back the Medicaid I used because I made too much. So NOW I have to do what the guy called BUY IN. I'll have to send $433 the first of every month to Medicaid. However, I will now also be COVERED for Medicaid as well. So I'm back at square one. What's left will NOT cover my monthly bills. Not sure what's next because I've cut everywhere I can.

[Chant]

It is well known that generic drugs have little to no medical value, it more like taking a sugar pill. You want to deal with Medicaid in the right way, you will need to take away many of those liberal goodies the Medicaid people use like cab rides, Emergency rooms, dobubble dippers both the patient and doctors, and most importance is make Medicaid harder to get for new residence like making it a 5 year residency before you can receive Medicaid.

Quote:
Originally Posted by Linda_D
Here's my first idea for reforming Medicaid: require Medicaid providers/recipients to write/accept the use of generic drugs if they exist rather than brand name drugs.

This is what just about anybody who has prescription coverage in his/her medical insurance has to do these days. If there is no generic or the doctor chooses to write a name-brand prescription or the patient wants the name-brand, the insured person pays a larger co-pay. It seems to me that Medicaid recipients should follow this same rule.

If a generic exists, and the doctor or patient decide to use a brand-name drug instead of the generic, then charge the patient a token co-pay of $1-3. Even that small amount will convince patients to take generics if available.


Both these statements aren't exactlly on. And this comes from my family doctor - generic drugs can be as good as the brand name, however the dosages in generic drugs are, or might not be, as uniformed as in the brand name version. As with the Thyroid medication I am on. My doctor wanted me on the brand name Synthroid at the beginning, until he found the proper doseage. Once that was done, I was switched to the generic and after my bloodwork was checked, I was able to stay on the generic because the slight difference from pill to pill didn't matter to me. My sister on the otherhand - with the same condition - has to stay on the brand name Synthroid because she cannot tolerate the slight differences in the generic pill to pill.
Depends on the patient and what the Dr. thinks is best for the patient. I don't think a patient should be held accountable for their dire needs.
If you want to cut the costs.... make it impossible for people to travel to NYS just for the free medical benefits. Have a residency requirement. Anyone who has worked in a hospital knows what I'm talking about with these 'vacationing patients".

[WNYresident]

Here's my first idea for reforming Medicaid: require Medicaid providers/recipients to write/accept the use of generic drugs if they exist rather than brand name drugs.

This is what just about anybody who has prescription coverage in his/her medical insurance has to do these days. If there is no generic or the doctor chooses to write a name-brand prescription or the patient wants the name-brand, the insured person pays a larger co-pay. It seems to me that Medicaid recipients should follow this same rule.

If a generic exists, and the doctor or patient decide to use a brand-name drug instead of the generic, then charge the patient a token co-pay of $1-3. Even that small amount will convince patients to take generics if available.

NO, you make them pay the FULL cost difference. What makes that person any more entitled that they can get name brand for a couple of bucks while other people would have to pay the full difference.

[dars00]

Here's my first idea for reforming Medicaid: require Medicaid providers/recipients to write/accept the use of generic drugs if they exist rather than brand name drugs.

This is what just about anybody who has prescription coverage in his/her medical insurance has to do these days. If there is no generic or the doctor chooses to write a name-brand prescription or the patient wants the name-brand, the insured person pays a larger co-pay. It seems to me that Medicaid recipients should follow this same rule.

If a generic exists, and the doctor or patient decide to use a brand-name drug instead of the generic, then charge the patient a token co-pay of $1-3. Even that small amount will convince patients to take generics if available.

This is already being done for the last 5 or so years.

[PickOranges]

1. You eliminate all the cadillac options in the entire program.

2. You eliminate the Home relief Program completely. This is the part for single people or people who been on the welfare longer than 5 yrs.. When a person refuses to work, they close out the cash assisstance but continue medicad no matter what. The state pays 50% and the counties paid 50%

3. You go after the fathers who have children on medicaid.. They have an obligation to pay support but you can't find them or restrict these provisions.

4. You obligate the mother for workfare for this program and cut her off of medicaid for not going. They can't cut a person off of medicaid which is 50% federal, 25% state and 25% county.

5. Clinton imposed 5 yrs limitation but what NYS did was changed the category to Home relief after 5 yrs and kept them on.. Thus again 50% state and 50% county reimbursement.

[Linda_D]

1. You eliminate all the cadillac options in the entire program.

2. You eliminate the Home relief Program completely. This is the part for single people or people who been on the welfare longer than 5 yrs.. When a person refuses to work, they close out the cash assisstance but continue medicad no matter what. The state pays 50% and the counties paid 50%

3. You go after the fathers who have children on medicaid.. They have an obligation to pay support but you can't find them or restrict these provisions.

4. You obligate the mother for workfare for this program and cut her off of medicaid for not going. They can't cut a person off of medicaid which is 50% federal, 25% state and 25% county.

5. Clinton imposed 5 yrs limitation but what NYS did was changed the category to Home relief after 5 yrs and kept them on.. Thus again 50% state and 50% county reimbursement.

I think you are addressing primarily welfare issues. The federal government mandates who is eligible for Medicaid, and while most welfare recipients are eligible for Medicaid, many people who are NOT on welfare are also eligible for Medicaid. The elderly who are in long-term care (nursing homes) are one group who comes to mind -- because of SS, most would NOT qualify for welfare but they do qualify for Medicaid because of the costs of nursing homes.

We probably need a separate thread for the welfare ideas.

[PickOranges]

I think you are addressing primarily welfare issues. The federal government mandates who is eligible for Medicaid, and while most welfare recipients are eligible for Medicaid, many people who are NOT on welfare are also eligible for Medicaid. The elderly who are in long-term care (nursing homes) are one group who comes to mind -- because of SS, most would NOT qualify for welfare but they do qualify for Medicaid because of the costs of nursing homes.

We probably need a separate thread for the welfare ideas.

I am addressing the medicaid portion of the welfare program..

Welfare consist of Cash assistance, foodstamps and medicaid.. You can also lump in HEAP since the welfare workers do that too, Red Cross reimbursements etc.

You can apply all together or separately.

You can be in a drug and alcohol treatment program for years.. very few graduate- all paid by medicaid. You are exempt from the work requirements

[gorja]

Originally posted by PickOranges:
1. You eliminate all the cadillac options in the entire program.

Look at them-
PROVIDER SERVICES (6)
- Prescription and non-prescription Drugs
- Private Duty Nurses
- Psychological Services
- Transportation Services
- Rehabilitative Services
- Optometrists' Services
HOSPITAL /CLINIC (13)
- Dental Services
- Case Management Services
- Physical Therapy
- Occupational Therapy
- Speech, Hearing and Language Therapy (3)
- Emergency Hospital Services provided in
non-Medicare participating Hospitals
- Hospice Care
- Diagnostic Services
- Screening Services
- Preventive Services
- Clinic Services
MEDICAL EQUIPMENT (5)
- Eyeglasses
- Prosthetic and Orthotic Devices
- Hearing Aids
- Prescription Shoes
- Dentures
OTHER (6)
- Intermediate Care Facilities for Persons with MR/DD and related Conditions
- Inpatient Psychiatric Services for Persons under Age 21 and Those over Age 65
- Nursing Facility Services for Persons under Age 21
- Personal Care Services
- PACE All Inclusive Care for the Elderly
- TB-related Services
http://www.wgrz.com/news/local/story.aspx?storyid=74949
Do they pay co-pays for any of these?

Posted by Linda D:
If a generic exists, and the doctor or patient decide to use a brand-name drug instead of the generic, then charge the patient a token co-pay of $1-3.

If a generic exists and they use the brand name, they should pay full cost. There is nothing wrong with using a generic.

[PickOranges]

Look at them-
PROVIDER SERVICES (6)
- Prescription and non-prescription Drugs
- Private Duty Nurses
- Psychological Services
- Transportation Services
- Rehabilitative Services
- Optometrists' Services
HOSPITAL /CLINIC (13)
- Dental Services
- Case Management Services
- Physical Therapy
- Occupational Therapy
- Speech, Hearing and Language Therapy (3)
- Emergency Hospital Services provided in
non-Medicare participating Hospitals
- Hospice Care
- Diagnostic Services
- Screening Services
- Preventive Services
- Clinic Services
MEDICAL EQUIPMENT (5)
- Eyeglasses
- Prosthetic and Orthotic Devices
- Hearing Aids
- Prescription Shoes
- Dentures
OTHER (6)
- Intermediate Care Facilities for Persons with MR/DD and related Conditions
- Inpatient Psychiatric Services for Persons under Age 21 and Those over Age 65
- Nursing Facility Services for Persons under Age 21
- Personal Care Services
- PACE All Inclusive Care for the Elderly
- TB-related Services
http://www.wgrz.com/news/local/story.aspx?storyid=74949
Do they pay co-pays for any of these?



If a generic exists and they use the brand name, they should pay full cost. There is nothing wrong with using a generic.

Amazing.. I know there are many options BUT this is an abuse. People with regular insurance don't get this.