State Health and Human Services officials unveil their plan to create health services accounts for some Medicaid recipients. The plan is a key provision of Granite Care -- Commissioner John Stephen's proposed Medicaid overhaul. As New Hampshire Public Radio's Josh Rogers reports, details remain sketchy.
Heath and human services commissioner John Stephen opened the presentation before house lawmakers with a simple plea...
"If you could just be open minded on behalf of the department. You are going to hear issues that could go both ways, but the issue at the end of the day is what is best for our children and our pregnant women."
And what the department has repeatedly said is best for pregnant women and children on Medicaid is for them to "get some skin in the game." According to state Medical Director William Kassler that concept translates to allowing recipients to manage their own expenses --- thus creating the incentive for them to become better heath care consumers. Kassler told lawmakers the department crafted its approach to an admittedly complicated matter with a specific audience in mind.
"There are many ways to provide incentives for prevention. We are proposing one that emphasizes personal responsibility and personal choice and hews to polices currently in favor in the White House."
Details of the how the plan would actually achieve it's goals are far from clear. As outlined, the plan would give Medicaid some recipients with incomes at 133 percent of poverty health services accounts to be used for medical expenses. The money in the accounts would be pegged to what the department calls soft caps. If account holders spent more than this unspecified allotment, they could be eligible for waivers. Dr. Kassler says the standard for granting such waivers remains a work in progress.
"If they run out of money and they have an accident emergency room visit....that would be waived. If they develop a serious illness that would be waived. The discussion of whether to waive less urgent care is one that the department has not resolved and we have not made any decisions."
Similarly nebulous is how the proposal would encourage consumers to be wise stewards of their account allotments. Commissioner Stephen has aired the idea of rewarding Medicaid recipients for embracing preventative care by awarding stipends for things like summer camp or membership to a gym. Again state medical director William Kassler.
"If this goes forward, I would pose that in spite of the Commissioner's examples of what he would find useful, we would have to go out and ask individuals in focus groups what sort of incentive would make this useful in your life -- And again, we haven't done that."
"So why is it that we are looking to dismantle a successful program for a concept that has never been tested on low-income families?"
That's Tricia Brooks. She heads the healthy kids corporation --the entity that oversees the state's non-Medicaid children's heath insurance program. Brooks told lawmakers that the Health Service accounts plan is riddled with flaws. These ranged from steep start-up and administrative costs, to the inequity of the seeking a disproportionate amount of savings from a small portion of the Medicaid program. Brooks call for the legislature to move with caution is likely to be heeded. After the hearing, lawmakers were universal in their call for more information.
"As it was presented, it's certainly not fleshed out enough so the legislature to consider enacting. At the moment they are not even for enough along the way so that even a bill could be drafted."
That's Weare Representative Neal Kurk. Kurk says the idea of giving people more control over their health care decisions is appealing, but says the topic will likely have to wait until next year. Far sooner than the timetable predicted by Stratham republican Rogers Johnson.
"In order for the legislature to approve it, we need to be comfortable that what we see is actually going to occur, and if this presentation keeps up we're never getting there."
The department says it will continue to work on it's health services account proposal. In the meantime, Governor John Lynch -- who has no plans to address Medicaid reform in his state budget proposal -- Lynch's has scheduled two Medicaid forums next week in Littleton and Nashua. Lynch has said the he hopes to move the Medicaid discussion beyond Commissioner Stephen's GraniteCare proposal.
