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By Pat Bellinghausen

Montana public health officials have undertaken a long-overdue effort to redesign state-funded health-care programs. Medicaid and other programs, such as the Children's Health Insurance Program, must change to meet the goals of serving needy Montanans and the demands of funding limits.

This redesign idea came from the Department of Public Health and Human Services. It was championed by Gov. Judy Martz and approved by the 2003 Legislature as House Joint Resolution 13.

Martz then appointed 18 people to a health advisory council, which is working to make recommendations to the governor for her consideration as early as this spring.

When the advisory council meets Monday in Helena, members will hear that DPHHS is focusing on a plan to transform the state's non-Medicaid Mental Health Services Plan into a special Medicaid program. Such a change could allow the state to get federal funding for a program that has been100 percent state funded. The federal Department of Health and Human Services would have to agree to a waiver.

This idea should be explored, but Montanans need to be wary of trade offs. HHS officials have floated proposals that would extend greater Medicaid support to states in the short term, but cap federal assistance in the long term. Thiscould mean, for example, that the state would get more federal help for a couple of years, but would get no more federal money if the number of Medicaid-eligible Montanans increased in future years.

The No. 1 financial problem of Montana Medicaid has been increases in the number of needy people entitled to service.

Consider the consequences

Medicaid redesigners must consider short-term and long-term consequences.

The planners at DPHHS, led by Director Gail Gray, want to improve the service to needy Montanans. But changes are likely to be driven by costs.

DPHHS has identified a long list of possible cost savings from Medicaid changes. Some are good ideas. For example, states have been working to recover Medicaid payments for nursing home carefrom individuals who transferred assets to qualify for Medicaid. The state ought to go further as some individuals are gaming the system with new strategies to shelter their assets. Such look-backs should be applied to other Medicaid recipients.

Other Medicaid cost-saving ideas involve restricting eligibility from poor people to poorer people. This accomplishes nothing. The problem isn't qualifying for Medicaid; it's accessing and paying for needed health care. If Medicaid is restricted, the state needs to create other ways for people to obtain affordable health care.

One of the myths of Medicaid is that it's a program for "welfare mothers."

Fund elder care

In fact, the single biggest expense of Montana Medicaid is nursing home care, which accounts for 27 percent of all spending. Not that Medicaid is paying high rates. In fact, Medicaid nursing home payments don't cover cost of care and result in cost shifting to private-paying residents.

To learn more

The Public Health Advisory Council is scheduled to meet Monday from 8:30 a.m. to 5 p.m. in Helena at the AARP conference room above the Silver Star Restaurant, 30 W. 14th St., Suite 301.

Medicaid redesign proposals are posted at the Department of Public Health and Human Services Web site: .

The aged account for only 7 percent of all Medicaid recipients, but use 29 percent of all the benefits paid. Similarly, blind and disabled Medicaid recipients are 13 percent of all recipients and use 36 percent of all benefits.

In the case of elderly nursing home residents, there aren't good ways to cut costs. However, senior nutrition programs and in-home services help keep some elders healthy at home. Future legislatures and future governors must face those facts.

Support healthy living

In the case of younger people with disabilities, Medicaid needs to support employment and self-sufficiency.This was a key finding of the President's New Freedom Commission on Mental Health. To stay healthy, people with disabling mental illnesses need safe housing and support to get and hold jobs. Living independently and working at least part time is much better for people and a lot less costly for the publict han hospitalization or institutionalization.

DPHHS and the redesign advisory council have a huge task. We urge them to seek changes that ensure each dollaris spent effectively. We urge them to focus on achievable goals that will strengthen the state's health-care safety net.

Copyright 2004, Used with permission from The Billings Gazette.