Medicaid's big problem

Friday, June 20, 2014

GLENDALE, Ariz. – Industry veteran and PMDRx CEO Gary Cox is making a bid for a seat in Arizona’s state senate. Unchallenged in the primary, he is on the ballot for November’s election. One of his priorities: fixing the state’s Medicaid system. Cox spoke with HME News about how his years in health care are informing his campaign.

HME News: What’s driving your campaign?

Gary Cox: Our state legislature voted for Medicaid expansion, and it has not figured out how to pay for this, once federal funding starts to decline. Having worked directly with various Medicaid contractors here in the state as a former DME supplier, I realized this is a big, big problem for our state. 

HME: What are some of the problems you see with Medicaid?

Cox: The Medicaid program contracts with payers that are profiting to the tune of $75 million a year in Arizona. The problem is that many are shortchanging the providers—the DME companies, the home health providers, the physicians. They use a lot of loopholes that are in place. 

HME: How would you fix those?

Cox: We have enough problems in this business without having to deal with not getting paid for legitimate services we’re providing. If I’m elected, I want to introduce some legislation to change some of the dynamics of the program to protect the actual healthcare provider. There are lots of protections for the payers. The state prohibits you from suing a contracted Medicaid payer. I would introduce legislation to give an option for litigation to the contractor, instead of giving the payer all the leverage.

HME: You’ve been in the healthcare industry for more than 40 years. How will your experience help other lawmakers?

Cox: There are a lot of incumbent state legislators who have some level of familiarity with access, but they really do not have in-depth knowledge in terms of Medicaid’s infrastructure and how it works, and how it affects providers. As someone who has interacted with Medicaid in our state, I really know where a lot of the flaws are.