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Thread: Ideas for Reforming NYS Medicaid

  1. #1
    Member Linda_D's Avatar
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    Ideas for Reforming NYS Medicaid

    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.

  2. #2
    Member Linda_D's Avatar
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    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.

  3. #3
    Member PickOranges's Avatar
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    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.
    Kiss someone that's different. It helps.
    Lets get the facts first, then go for the jugular!!
    It's all transparent, just read between the lines..

  4. #4
    Member Linda_D's Avatar
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    Quote Originally Posted by PickOranges View Post
    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.

  5. #5
    Member gorja's Avatar
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    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.
    Last edited by gorja; November 7th, 2010 at 08:59 AM. Reason: Added source


  6. #6
    Member PickOranges's Avatar
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    Quote Originally Posted by Linda_D View Post
    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
    Kiss someone that's different. It helps.
    Lets get the facts first, then go for the jugular!!
    It's all transparent, just read between the lines..

  7. #7
    Member PickOranges's Avatar
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    Quote Originally Posted by gorja View Post
    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.
    Kiss someone that's different. It helps.
    Lets get the facts first, then go for the jugular!!
    It's all transparent, just read between the lines..

  8. #8
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    Quote Originally Posted by PickOranges View Post
    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 like your ideas -- except, I may have misunderstood what you are saying about medical care. No one should ever be cut from medical care.

  9. #9
    Member PickOranges's Avatar
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    Quote Originally Posted by atotaltotalfan2001 View Post
    I like your ideas -- except, I may have misunderstood what you are saying about medical care. No one should ever be cut from medical care.
    I agree.. If you are able to work and pay for it then you should. You have a personal responsibility. This is law.

    For instance if you single and on wefare, a worker can place you to help at the Olmted Parks. But let say you refuse to go..

    Yrs ago, they cut of your cash assistance, FS and Medicaid. The state changed that and now you can't be cut off of medicaid for not getting up in the morning.

    I believe everyone should have healthcare too but it should not be free if you are able to do your part to give back..

    Could NYS have done it to ensure doctors get paid? or were they too liberal and didn't think a person should have some responsibility.

    I know if you take a person and keep them busy it has great long term benefits:

    1. It helps the community, shows an example to their kids( mom and Dad is working) , makes the fathers stay involved, keeps people of the street.. They put it on their resumes, people learn english. etc

    I can go on and on..
    Kiss someone that's different. It helps.
    Lets get the facts first, then go for the jugular!!
    It's all transparent, just read between the lines..

  10. #10
    Member NBuffaloResident's Avatar
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    Quote Originally Posted by PickOranges View Post
    Amazing.. I know there are many options BUT this is an abuse. People with regular insurance don't get this.
    People with regular insurance should get all of that. It's criminal they don't.
    Raptor Jesus: He went extinct for your sins.

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    Quote Originally Posted by NBuffaloResident View Post
    People with regular insurance should get all of that. It's criminal they don't.
    for starters, only legal residents of NYS should be eligible for medicaid. (that is, legal citizens of USA)

    healthcare unions will never allow any meaningful medicaid reform (an oxymoron by any definition)

    as long as NYS offers more bennies than California, the dependent masses will continue to flock here for medicaid, creating more demand for healthcare workers, including EMT drivers who are often used as taxicab services.

    the real purpose of keeping medicaid spending high is to transfer wealth from your pockets to the healthcare unions, who will continue to support the politicos that help keep medicaid spending as high as it is, resulting in long term job security, bennies for both the healthcare folks and the politicos, while creating a dependent class that will always vote for the the guy giving them the free stuff.

    it's an unholy alliance. unions win, politicos win, private sector picks up the tab (loses). it also keeps NY State firmly in Democrat hands for both statewide and national elections for years to come.

    it's no accident that NY Medicaid spending is so high. just follow the money trail; that will explain why no change will be forthcoming in our lifetimes.

  12. #12
    Member 300miles's Avatar
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    Linda provided a really good link to Medicaid info on eligibility. I would encourage everyone interested in ways to cut medicaid to read that document first before listing out what you think should be cut.

    NYS is not allowed to cut whatever it wants. It's not allowed to create certain restrictions. But there are some areas that are 'optional' and that could be eliminated.

    Thanks Linda for starting this thread!

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    Member Riven37's Avatar
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    !

    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 View Post
    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
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  14. #14
    Member 300miles's Avatar
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    Quote Originally Posted by Riven37 View Post
    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.

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

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