Herald News: State turning to HMOs for Medicaid

[Judi Lynn]

Source: Herald News

Herald News: State turning to HMOs for Medicaid
Wednesday, July 20, 2011

SPENDING ON Medicaid, which provides health care to citizens who are poor or permanently disabled, has been growing at a rapid clip. So the state is turning to managed-care organizations to handle virtually every patient, even those with extremely complicated needs, in its quest to flatten the cost curve.

It is a moment of great challenge and upheaval for patients and their families. But the shift to HMOs may also be the program’s best hope for stability. As state Human Services Commissioner Jennifer Velez recently told legislators, "The state must redesign the program if we expect to protect benefits to the most vulnerable."

Some 150,000 patients currently covered in traditional fee-for-service programs will soon be signed up with HMOs. As a group, they are defined by having medical conditions so complicated, the state has until now exempted them from the HMO bureaucracy. They include intellectually disabled adults with seizure disorders and heart murmurs, children in state care born with chromosomal abnormalities who rely on feeding tubes and round-the-clock therapies, and elderly men and women whose cocktail of daily medications has achieved a careful balance over time.

About 45,000 people are being required to sign up for one of four providers this month. The remainder, including AIDS patients, will have to sign on in the fall, all but freeing the state from the benefits and claims business. In addition, services such as prescription drugs and home health aides will now all be handled by the HMOs.



Read more: http://www.northjersey.com/news/opinions/125869983_State_turning_to_HMOs_for_Medicaid.html

[Bozita]

1. For too many, corporate death panels

[dkf]

2. Medicaid gives better care than hmo's?

[McCamy Taylor]

4. Yes, actually. Medicaid HMOs make money by restricting choice even more than it is already.

Insurers have only two ways to make money. One, cherry pick the healthy---i.e. avoid minorities and the disabled and aim for healthy, white kids. Or, two, deny care to those that need it by having so few providers that the wait to get service and the distances patients must travel to get service effectively deny them service.

When they tell you they prevent disease they are lying. The profit is all generated by the two strategies above. You have to cover the same folks for five to ten years to see any return on an investment in disease prevention. HMOs do not prevent disease. They prevent people with disease from joining their plans. And, when a "high utilizer" sneaks in, they go to drastic lengths to encourage him to get back out.

[eShirl]

7. +1

[cstanleytech]

3. Why havent the republicans attacked HMOs? They

are after all kinda like the so called socialized medicine that they rail against in that they dictate what procedures are and are not covered and you can (atleast from what I have read) literally die while waiting for procedure to be approved assuming it even is approved.

[McCamy Taylor]

5. Federal law provides a loophole called ERISA that exempts about half the plans in the country

from accountability for their bad medical decisions. If your employer pays for your insurance and the insurance denies you a CTscan and you later die of cancer, your widow can only recoup the cost of the CTscan. She gets nothing for the medical malpractice. This was an unintended consequence of a law---and Congress has done nothing to change it.

Anyone who thinks that Congress gives a flying fuck about their health care is delusional. To paraphrase Idiocracy, Congress to America "Fuck you! I have health insurance"

They need to give Congress a Medicaid HMO.

[mucifer]

6. They are doing this in IL too. Some of these plans are so crappy

that I am having problems getting decent docs to see my pts. These docs would see them if they had medicaid.