States Have Greater Flexibility in Benefits, Cost Sharing
Centers for Medicare and Medicaid Services (CMS)
February 21, 2008
Two new proposed rules that would give states unprecedented flexibility in designing their own Medicaid programs, including adjusting their benefit package to more closely align with beneficiary needs and requiring increased cost sharing by enrollees, were announced today by the Centers for Medicare and Medicaid Services (CMS).
The proposed rules would implement provisions of the Deficit Reduction Act of 2005 and the Tax Relief and Health Care Act of 2006. The rules are the latest in a series of regulations to implement the AdministrationĆ¢ā¬ā¢s goals of aligning Medicaid more closely with private market insurance and giving states more control over their Medicaid benefits packages.
“These new rules recognize that states are in the best position to design plans that provide Medicaid beneficiaries better health care for the same or even lower cost,” Health and Human Services Secretary Mike Leavitt said. “The proposed rules will result in patients having more choices and greater control over their health care decisions.”
Individuals with family incomes between 100 and 150 percent of the FPL may see some cost sharing while monthly premiums can be charged to individuals with incomes above 150 percent of the FPL. As in SCHIP, all cost sharing must be limited to no more than five percent of the familyĆ¢ā¬ā¢s income. The 2008 FPL for a family of four is $21,200.
“Until passage of the DRA, states had few options, other than through waivers, to update the health benefit packages offered through their Medicaid programs to meet the needs of the people they serve,” CMS Acting Administrator Kerry Weems said. “These proposed changes allow states to use modern methods of providing health insurance coverage and encourage families to participate in their own health care decisions.”
http://www.cms.hhs.gov/apps/media/press/release.asp
(Click release for February 21, 2008)
Comment:
By Don McCanne, MD
So under the new rules, a family of four living at the federal poverty level ($21,200) can be granted “greater control over their health care decisions” by being granted the opportunity to use $1060 of their own income in order to make them better health care shoppers.
These are families who are not facing foreclosure on their homes (since they could never qualify to purchase them in the first place). They are not facing repossession of their automobiles (since they have, at best, a clunker, or they use public transportation). They are not impacted by a mandate to buy insurance on their clunker (since they have no funds to purchase the required coverage anyway). These are families who will not have to face additional credit card debt (since any cards they have are already maxed out, and they cannot qualify for new cards). These are families who are able to regularly experience new living environments (each time they are evicted for failing to pay their past due rent). These are families who have become very adept at budgeting (since they must stretch their $407 per week to cover their rent, food, clothing, utilities, transportation, school supplies, etc., etc.).
Many studies have shown that cost sharing in health care literally can be a death sentence, especially for those living at or near the poverty level. Secretary Leavitt and Administrator Weems already know this.
What kind of nation have we become?