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Editorial: Changes Will Buy N.M. Medicaid Time

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Medicaid, the federal program that provides health care to low-income children, the elderly and disabled, is growing by leaps and bounds. Last year it took up 12 percent of the state budget. This year it will eat up 16 percent — around $870 million. If/when the Affordable Care Act kicks in, an additional 175,000 New Mexicans are expected to join the current 560,000 people already on the state’s Medicaid roles.

And unless the state wants to spend an ever-increasing portion of its budget on Medicaid, it must start reining it in with changes like those proposed by Human Services Secretary Sidonie Squier.

Her plan, unveiled this week, is designed to slow growth in spending without reducing eligibility for the program or cutting services or payments to medical providers. The proposed changes streamline the administration, push patient education on how to best utilize services, add small co-pays for unnecessary use of brand-name drugs and emergency rooms, and encourage managed-care companies to deliver outcomes rather than simply provide services. Some changes will require federal approval, which explains why the state is settling for baby steps.

The bottom line is “we really don’t know what we’re buying with Medicaid dollars,” Squier says. “That can’t stand. We want outcomes. We want people to get better and to stay better.”

Health plans will have to provide care coordinators — clinicians or nurses — to monitor patient care, eliminate duplicative tests and ensure primary care doctors and specialists are all on the same best-practices page for physical and behavioral health. The plan will incentivize patients to take healthy steps, giving gift cards or health-care payment credits for positive behavior. A pilot program would put in place penalties for providers when patients are readmitted for certain conditions (such as pediatric asthma) within 30 days — the goal is to ensure patients have the information and support they need when discharged.

Meanwhile, the state will seek to eliminate excessive paperwork by combining 11 of its 12 Medicaid waivers for specific populations under one form number, reduce the number of health plans it works with and propose that Native Americans use managed-care plans to achieve better outcomes than they now get under fee-for-service programs.

Medicaid cost federal taxpayers $3.8 billion in fiscal 2012 for New Mexico alone, and the state’s share promises to go nowhere but up — as the number of patients is increasing, the federal match is decreasing. Stanching some of the red ink while improving patient outcomes is an important first step to making, and keeping, this health-care safety net sustainable.

This editorial first appeared in the Albuquerque Journal. It was written by members of the editorial board and is unsigned as it represents the opinion of the newspaper rather than the writers.

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