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Maryland medicaid and welfare: too 'Stimulated'

by George Liebmann

Maryland spent some $4.7 billion on its Medicaid program in 2004,and $5.3 billion in the current year of which $2.5 billion represented state funds. The current administration has expanded dental care coverage, creating what amounts to a new entitlement program for providers, as well as expanding eligibility for the basic medicaid program. It has been less interested in curbing medicaid fraud, legislation which would have added resources for this purpose failing in the 2008 and 2009 General Assembly, partly by reason of industry arguments that most of the recoveries that might be obtained would inure to the benefit of the federal government and not the state. The state has also done little to promote care-giving by relatives as an alternative to medicaid nursing homes, and has done nothing to liberalize its accessory apartment laws or provide incentives for the creation of second kitchens in single family homes, even though 70% to 80% of medicaid spending is for nursing home care. Its efforts to discourage emergency room use by encouraging primary care clinics in inner-city areas have been intermittent and inadequate, nor has it done much to enhance the role of nurse practitioners. There are estimates that Maryland may receive between $1 billion and $1.4 billion in health care funds from the stimulus funds over a two year period, leading some to predict an 18% increase in medicaid spending and others to propose extending the program to some childless adults. How these increases will be sustained if and when the temporary appropriations are ended is little discussed.

Maryland has done a credible job in implementing the 1996 federal welfare reform legislation, although its implementation of time-limit provisions is week and its sanctions regime is mediocre. One survey credits it with the best overall implementation of the law among the 50 states. Its caseload reduction over a ten-year period was 78.9%, the eleventh largest in the country, and it also made good progress in reducing its poverty rate and teen birth rate and in enforcing work requirements. See G.Macdougal et al, State Welfare Report Card 2008: Welfare Reform After Ten Years (Heartland Institute, 2008).The stimulus bill provides incentives to relax restrictions, raising the danger that any relaxation will outlast the funds providing an incentive for it.

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