The report indicates that Medicaid presently covers 22 percent of Alabamians and pays for 53 percent of births, 47 percent of children, and almost two-thirds of nursing home residents.
Surprisingly, Alabama not only provides additional services above and beyond any requirements for Medicaid but has expanded some coverage in 2013.
The report credits the recent increase in Medicaid recipients in Alabama as the result of the recession and notes that Alabama has the third lowest cost per Medicaid recipient in the United States..
The solution requires the Federal Government to pay for the majority of changes that will reduce Alabama’s unsustainable costs for Medicaid that exceed two billion dollars.
This is a deft political ploy on the part of Bentley and the Alabama Medicaid Advisory Commission. President Obama cannot afford to offend his Democrat base in Alabama by refusing to fund the proposed program change nor can he afford to open the door to any litigation against the Patient Protection and Affordable Care Act (PPACA) by refusing to fund the program changes proposed in Alabama.
The ploy may extend any confrontation about Medicaid in Alabama past the newly negotiated measures that will avoid a new fiscal cliff until Mar. 2013.
The proposed changes in Medicaid in Alabama are: 1) Alabama be divided into regions and that a community led network in each region coordinate the health care services of the Medicaid patients in that region; 2) Regional care networks formally engage consumer input and oversight at all levels of governance and operation; 3) The expanded regional patient care networks become risk-bearing organizations; 4) Regions may choose to contract with a commercial managed care organization to provide care, risk management, or other services in the region; 5) The Legislature where appropriate, and Medicaid where administratively possible, shall authorize regional care networks throughout the state and establish an implementation timeline. Specific benchmarks shall be set that must be met by the networks. Failure to meet the benchmarks shall authorize state intervention; 6) The Alabama Medicaid Agency should seek an 1115 waiver from CMS to implement the transformation to managed care; and 7) Legislation should be developed to create a Medicaid cap, provided that the legislation ensures adequate flexibility for the Alabama Medicaid Agency to address federal mandates, rules, and regulations; economic uncertainty; catastrophic health events; and provider rates.
Additionally the Alabama Medicaid Advisory Commission recommended: 1) The Commission strongly supports efforts to identify and punish fraud and abuse in the Medicaid program; and 2) Because of the significant portion of Medicaid expenditures excluded from consideration when LTC (Long Term Care) and waiver populations are excluded, the Commission strongly supports the efforts of provider organizations that will in the near future develop programs for coordination of LTC and waivers.
These recommendations were not mentioned by Governor Bentley but can be seen in the Alabama Medicaid Advisory Commission’s full report here.