HHS Announces Basic Change in Medicaid

[NRSKarenRN, BSN, RN]

States Would Have Latitude to Trim Options, Expand Federal Coverage to More People

Health and Human Services Secretary Tommy G. Thompson said the number of uninsured has dropped. (Fox News Sunday)

By David S. Broder and Dan Balz

Washington Post Staff Writers

Sunday, August 5, 2001; Page A02

PROVIDENCE, R.I., Aug. 4 -- The Bush administration announced today a fundamental change in the federal-state Medicaid program designed to reduce the number of uninsured Americans without increasing the cost of the program.

The plan announced by Health and Human Services Secretary Tommy G. Thompson would allow states to trim some optional benefits and use the savings to expand the number of people with health insurance. States would be required to document how they would reduce the number of uninsured.

At the same time, Thompson assured a closed-door luncheon at the start of the National Governors Association annual meeting here that the Bush administration was not trying to eliminate state family planning services. Thompson said that, in the past week, HHS had approved proposals to continue or expand those programs in New York and Missouri and said, "I expect all [the other pending applications] will be approved."

Thompson, the former governor of Wisconsin, said he was asking states seeking to expand the contraception information and equipment programs to broaden their applications to include primary care for all women who seek help.

Some family planning groups had expressed concerns that HHS was delaying approval of the applications while pushing "abstinence-only" programs as an alternative.

In his weekly radio address, President Bush said the new Medicaid policy would let states lead the way in forming Medicaid while helping to "ensure that their programs broaden coverage for low-income Americans."

Thompson said that the number of Americans without health insurance has dropped from 42.8 million to 39.3 million, according to a new survey by his department. He acknowledged that some of the reduction came from a change in survey methods but said that waivers he has granted, along with more aggressive efforts by the states, have added at least 800,000 people to the ranks of the insured.

Thompson also said that HHS had cleared up 910 pending waiver requests, leaving only 36 awaiting action. He promised they would be done by September.

He outlined a new waiver-request form, which will be posted on the HHS Web site, to speed action on future applications.

Medicaid is a federal-state insurance program that provides benefits for families on welfare and other low-income people. In recent years, as welfare rolls have declined, many states have used the funds to insure the working poor. States also have begun to implement a separate program designed to insure children in low- and middle-income families.

The new policy will make it easier for states to combine Medicaid and SCHIP (state children's health insurance program) funds in a coordinated effort to reduce the ranks of the uninsured.

Benefits for the working poor -- but not families on welfare -- could be reduced if the state decided to use those funds to expand coverage to the uninsured. That feature may well draw criticism from congressional Democrats, officials acknowledged, as a retrenchment in health care coverage.

But Vermont Gov. Howard Dean (D), a physician who has been a leader on health care issues for his party, joined Thompson at a news conference to praise the initiative. Dean said it would help his state and "is very close" to the policy recommendations the governors have made on a bipartisan basis.

He and Iowa Gov. Tom Vilsack (D) said "the devil is in the details" and expressed concerns that the Office of Management and Budget may take a restrictive view that would inhibit state efforts to accomplish what Bush and Thompson said they want.

On the family planning issue, Thompson released a letter to Rep. James C. Greenwood (R-Pa.), who had expressed his concern about the delay in approving several state applications.

"The department does not have a problem with states expanding access to family planning services," Thompson said, adding that "none of the eight waiver applications have been denied. I expect all will be approved. . . . I want to reaffirm that Medicaid recipients continue to have full access to family planning services."

During the campaign, Bush expressed a preference for abstinence-only programs, saying that discussing the use of condoms and other contraceptives with young people sends "a mixed message."

© 2001 The Washington Post Company

[fiestynurse]

The formula is simple: (no change in Medicaid contribution to

funding) plus (increased numbers of low-income individuals covered) equals (reduced benefits for those currently covered)

Medicaid is being converted from a defined benefit program to a defined contribution program. This shift in policy controls the government's costs while placing a greater burden on the Medicaid beneficiary by removing essential benefits from the program which now will either have to be paid for out-of-pocket, or, more likely, will be no longer be accessible simply because of lack of affordability. We have the resources to provide comprehensive care for everyone. It is inexcusable that the President of the United States is deliberately

decreasing access to essential medical care for the most vulnerable members of our society merely so that he can assure that his tax cuts for the wealthy will be protected.