Governors come up with some ideas for Medicaid

WASHINGTON -- The National Governors Association (NGA) this month presented to Congress its preliminary recommendations for Medicaid reform, including the improvement of access to homecare, during testimony before the Senate Finance and House Energy and Commerce committees. Testimony by NGA Chairman Virginia Gov. Mark Warner and Vice Chairman Arkansas Gov. Mike Huckabee, outlined the findings of the association's report. The report lays out several recommendations for immediate reform, but also emphasizes the need to address the outside factors driving Medicaid growth -- the cost of health care, the erosion of employer-sponsored health insurance, and the cost of longterm care, said Matt Salo, the director of the NGA's health and human services committee. Salo said the NGA's commission is looking for ways to slow the growth of the program. During the past five years, Medicaid has grown 40% with 15 million people joining the program. "We have to figure out a way to make Medicaid less necessary," he said. "It is a safety net program, and that's what it should be. But with 53 million people total, it seems like an awful lot more than just a safety net." Reducing the ranks means addressing the outside factors driving growth, including addressing the cost of long-term care. In terms of longterm care, the report advocates giving the states "more tools to encourage home and community-based care and could include the elimination of the requirements for a waiver for home- and community-based care." "From a public policy perspective, yes, the shift has to be towards more homecare, but so often in the past, that debate has ignored the issue of who is going to pay for it," said Salo. While the NGA agrees that the cost of homecare is less expensive per person, Salo said the concern is that the overall cost could be more because more people want homecare services than nursing home care. The NGA will share its preliminary findings with the federal Medicaid commission that formed out of this spring's Medicaid budget talks. Salo said, however, that no governors will serve as voting members on the commission. Instead the NGA will offer staffing services and will work to get state Medicaid directors involved in the process. "We had our commission, and we are really hitting our stride, so it didn't make sense to splinter off and join someone else's commission. We wanted to keep going in the direction we were headed. The NGA's report was developed by a bipartisan working group of 11 governors, who began discussion late last year. It also received input from Medicaid directors and governors from more than 30 states.