confront 700 county residents
Express Staff Writer
A plan Gov.
Dirk Kempthorne revealed earlier this month would save money on state
healthcare expenses by giving the Department of Health and Welfare the
authority to change the way it manages Medicaid. The publicly funded
medical insurance system provides healthcare to the most needy men, women,
seniors and children when they have no other options.
would shave $15 million off Medicaid’s budget statewide. Healthcare
providers in the Wood River Valley say the changes would have little
effect on their finances and ability to provide services. But the county’s
704 residents currently enrolled in Medicaid may find less flexibility in
the way they buy drugs and visit hospitals.
by the Legislature, Kempthorne’s plan would require recipients to
contact Medicaid for prior authorization when they require more than four
prescriptions at one time. The rule would affect seniors, who most often
use multiple prescriptions.
would also be required to use most of a prescription before getting it
refilled, a measure that would be aimed at preventing patients from
stockpiling drugs and at thwarting criminals who acquire narcotics through
Medicaid to sell on the streets, Kempthorne told the Idaho Legislature
when he outlined the plan in his Jan. 9 budget address.
would also include improving the bond between doctors and patients and
aligning Medicaid reimbursements to that of Medicare, the federal program
that provides similar services to Medicaid but typically reimburses
providers at a lower rate.
Wood River Medical Center, the county’s major hospital, received
approximately $600,000 from Medicaid in 2001, said the hospital’s public
relations manager, Kerry George. That amount was 5.2 percent of the
hospital’s gross revenue. St. Luke’s treated Medicaid patients 122
times last year.
though we’re a wealthy community, we still have a great need (to treat
the poor) here," she said. "That doesn’t mean we always see
much the proposed changes would reduce Medicaid payments to St. Luke’s
is not clear, since a large portion of the savings would come from
reforming the way drug prescriptions are filled, something St. Luke’s
does not do.
proposed plan, Medicaid would also review hospital records after a patient’s
third day at a hospital, rather than after the fourth day, as it does now.
The reviews would be aimed at helping hospitals facilitate the transfer of
patients to nursing homes and rehabilitation facilities, when appropriate,
which would save money, said Tom Shanahan, spokesman for the Department of
Health and Welfare.
is already managing its length of stays, which averaged 2.6 days last
year, George said. So, a review after three days "would not impact us
in a significant way."
percent of the residents at Blaine Manor, the county’s only skilled-care
nursing home, are on Medicaid, said Gail Goglia, the home’s director.
gets prescriptions filled for its residents and residents typically stay
for more than four days, so they should not be directly impacted, Goglia
Medicaid reimbursements have been slowly declining from a rate of $152 per
day for each recipient two years ago to a rate of $133.75 today, she said.
The average cost each day of keeping a resident is $240.
reimbursement "is a big issue for everyone that takes care of people
in nursing homes," she said.
Welfare and the governor would also extend the Healthy Connections program
to most of the state’s 130,000 Medicaid recipients. Healthy Connections
works at strengthening the doctor-patient bond allowing doctors to treat
problems before they result in costly emergency-room visits.
of these people are not used to having regular medical care, so they wait
until they’re really sick," before seeing a doctor, said Shanahan.
Connections does not operate in Blaine County, said Sue Harvey, a Health
and Welfare employee who has been working to expand the program in South
enact these measures now, we will reduce what would have been more than a
$30 million increase (in Medicaid’s 2003 budget) to a more manageable
$15 million increase," Kempthorne said. "If we do nothing, we
will see costs continue to spiral out of control."
not trying to cut services, what we’re trying to do is keep an eye
on" expenses, said Shanahan.
Manor’s Goglia, is skeptical.
right when the say they’re changing the way Medicaid is managed, but the
result would be some cuts in some programs," she said.
Health Care Association, which focuses on nursing home issues, expects
Legislators to cut Medicaid even further this winter. So does Rep. Wendy
there is already talk among some legislators of eliminating Medicaid’s
women and children’s program for prenatal and infant care.
get down toward looking at changes in Medicaid, there’s going to be a
lot of screaming out of the public. And I think that there’s going to be
an opportunity to re-evaluate programs," said Rep. Tom Loertscher,
R-Iona, Chairman of the House Health and Welfare Committee. "Whether
or not we’ll have the courage to do the things we need to do, I’m not
concerned that the proposed changes will fail at saving the targeted $15
million, which would mean a shortfall in the state’s overall budget.
at Blaine Manor and St. Luke’s emphasized that the plan is only a
proposal and could change drastically as it makes its way through the
state Legislature this winter.
Finance-Appropriations Committee must approve the plan, which could happen
in the next few weeks, before the plan goes before the House and Senate
for final consideration.
would be aimed at slowing Medicaid’s rate of growth, which has been 16
to 25 percent over the last two years, to 6 percent in the coming year,
governor, facing the worst state budget crisis in 18 years, earlier this
month ordered reductions averaging 10 percent for all agencies, except for
Medicaid, corrections, public schools and veterans.