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Volume 12 Number 115 News: Medicaid States are coming up with innovative ways to deal with managing Medicaid costs and quality, and coping with an aging population, the biggest issues that states face, speakers said June 13 at the Second National Medicaid Congress. "A lot of activity is happening in the states and Kentucky" when it comes to Medicaid, said Mark Birdwhistell, secretary for the Kentucky Cabinet for Health and Family Services. Kentucky has instituted a program called "Get Healthy Kentucky" that increases covered Medicaid benefits for those who follow a wellness program. The state also has disease management programs for those with chronic illnesses such as diabetes. The "initial returns are exceptional," Birdwhistell said. North Carolina also is "moving aggressively" toward disease management for those with conditions such as asthma and diabetes, Carmen Hooker Odem, secretary of the North Carolina Department of Health, said. Dealing With an Aging Population When it comes to the elderly, Arkansas spends "90 percent of the money on 10 percent of the population," said John Selig, director of the Arkansas Department of Health and Human Services. To deal with the aging population, Arkansas has passed a law that requires anyone going into a nursing home to be screened first by a nurse, Selig said. There is a "big push" in the state to keep people out of institutions. Iowa also is dealing with an aging population. In fact, Iowa has the highest rate of any state of those in nursing homes, said Kevin Concannon, director of the Iowa Department of Human Services. The state also has adopted a strategy to encourage use of community-based care options. To help the elderly and the disabled, Kentucky has created a department called the Department of Aging and Independent Living, said Birdwhistell. This department develops community-based systems of care that promote independence and protect the quality of life of the elderly and the disabled. Increasing Coverage Iowa has focused on increasing health insurance coverage. It is one of the few states that has increased coverage in both the public and private sectors, Concannon said. Iowa has implemented a limited-benefit, limited-network Medicaid program for individuals not typically qualified for Medicaid. One of the "biggest deterrents" to getting more people to enroll was the enrollment letter, Concannon said. Iowa changed the format of the enrollment letter to make it less confusing and is moving to a Web-based system so people can enroll online. In-office interviews also no longer will be required for Medicaid enrollment, he added. Arkansas has a program to help small businesses, those with fewer than 500 employees, provide health coverage. The state pays 85 percent of the cost for low-income employees but then small businesses have to cover the rest of the employees. "Businesses like it," Selig said. Kentucky also passed legislation to help small businesses that do not offer health insurance. The Medicaid program in Arkansas is "pushing to get better value for what we're spending" by tying pay to performance, Selig said. This strategy is important because the performance of providers "gets a lot better" if their pay is tied to performance. Electronic Health Information Poor people move at a higher rate, and therefore do not have the same health care provider over time, Concannon said. We now have a Web-based program that contains the claims history of patients in Medicaid that "gives a tremendous amount of information to providers." This is a low-cost way to provide information, Concannon said. These electronic medical records, while not complete, are useful, he noted. Kentucky was given a $5 million grant from the Centers for Medicare and Medicaid Services to put together a Web portal for basic health information. "Medicaid is leading the charge for e-health," Birdwhistell said. States "need help from the federal government for e-technology in Medicaid," Odem said. The federal government "should encourage and help every state with this." Pilot Program for Released Prisoners Iowa has implemented a "DMIE" (Demonstration to Maintain Independence and Employment) pilot program targeted at inmates who have mental health problems and who are being released from jail. "These individuals are a problem for every state," Concannon said. Usually, when these individuals get out of jail they get $50 and a 30-day supply of medications. DMIE provides Medicaid coverage to these individuals as soon as they get out. More information about the Second National Medicaid Congress is available.
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