Bush Says States May Shift Medicaid Sue Kirchhoff
August 06, 2001
c.2001 The Boston Globe
President Bush promised Saturday to make it easier for states to
redesign their Medicaid programs, including altering the mix of
benefits, in order to expand care to more of the uninsured, and
particularly to more families among the working poor.
In his weekly radio address, Bush said his administration would
adopt rules making it simpler for governors to get waivers to test
new approaches to Medicaid.
Medicaid is the joint state and federal program that provides
insurance to 40 million poor children, elderly, and disabled.
``The goals of Medicaid are too important to get bogged down in
a bureaucracy,'' Bush said. ``My administration cares about
results, about getting Americans broader and better medical
coverage.''
The streamlined waiver program would be targeted at, but not
restricted to, about 12 million individuals or families who are
classified as working poor, but whose income disqualifies them from
services under Medicaid's tight income rules, officials said.
States now serve those people under a series of programs run in
addition to the core Medicaid package.
Some states want to offer a less generous package of benefits
than now required under Medicaid, or under the State Children's
Insurance Program, in an effort to stretch their dollars farther
and serve more people.
They see such an effort as a way to cover entire families, for
example, rather than just children, under the State Children's
Insurance Program.
As of now, states have the option of applying for federal
waivers to experiment with new approaches to Medicaid and the state
children's program, which covers children from families whose
income precludes health coverage, but who make more than the cutoff
figure for Medicaid eligibility. Waivers can range from
comprehensive efforts at statewide health care reform to limited
changes in delivery of certain services. And past waivers have
allowed states to change the mix of program benefits.
The new initiative will emphasize coordinating the programs with
private insurance, such as offering a private health plan with
copayments and deductibles. In return for faster approval and more
flexibility, states will have to set goals for reducing the number
of residents without health care.
Bush, a former governor of Texas, and Health and Human Services
Secretary Tommy Thompson, the former chief executive of Wisconsin,
have promised to give states more power over the program.
Thompson briefed governors about the proposal Saturday at a
meeting of the National Governors' Association in Providence, R.I.
There was bipartisan support from the governors, who proposed
the type of flexiblity the White House is offering. But there was
some concern about whether funding levels would allow expansion of
coverage. There were also questions about the idea of cutting
benefits to some recipients.
Sarah Magazine, a spokeswoman for Acting Governor Jane M. Swift,
said that Swift will have members of her staff review the proposal
in detail to determine its effect on Massachusetts. Magazine said
Swift is generally supportive of the plan's stated goals.
``Thompson's plan will give increased flexibility to states,''
Magazine said. ``The more people we can get covered, the better.''
Currently, states run the Medicaid program under federal
guidelines. Those covered by the program receive a full benefit
package.
Since Bush took office, Thompson has approved more than 900
program changes and waivers. But states have also been feuding with
Thompson over his department's unwillingness to sign off on narrow
coverage expansions for services like family planning or
prescription drugs.
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