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For the week of Jan 30 - Feb 5, 2002


Medicaid changes confront 700 county residents

Express Staff Writer

A plan Gov. Dirk Kempthorne revealed earlier this month would save money on state healthcare expenses by giving the Department of Health and Welfare the authority to change the way it manages Medicaid. The publicly funded medical insurance system provides healthcare to the most needy men, women, seniors and children when they have no other options.

The plan would shave $15 million off Medicaid’s budget statewide. Healthcare providers in the Wood River Valley say the changes would have little effect on their finances and ability to provide services. But the county’s 704 residents currently enrolled in Medicaid may find less flexibility in the way they buy drugs and visit hospitals.

If approved by the Legislature, Kempthorne’s plan would require recipients to contact Medicaid for prior authorization when they require more than four prescriptions at one time. The rule would affect seniors, who most often use multiple prescriptions.

Recipients would also be required to use most of a prescription before getting it refilled, a measure that would be aimed at preventing patients from stockpiling drugs and at thwarting criminals who acquire narcotics through Medicaid to sell on the streets, Kempthorne told the Idaho Legislature when he outlined the plan in his Jan. 9 budget address.

Changes would also include improving the bond between doctors and patients and aligning Medicaid reimbursements to that of Medicare, the federal program that provides similar services to Medicaid but typically reimburses providers at a lower rate.

St. Luke’s Wood River Medical Center, the county’s major hospital, received approximately $600,000 from Medicaid in 2001, said the hospital’s public relations manager, Kerry George. That amount was 5.2 percent of the hospital’s gross revenue. St. Luke’s treated Medicaid patients 122 times last year.

"Even though we’re a wealthy community, we still have a great need (to treat the poor) here," she said. "That doesn’t mean we always see it."

Just how much the proposed changes would reduce Medicaid payments to St. Luke’s is not clear, since a large portion of the savings would come from reforming the way drug prescriptions are filled, something St. Luke’s does not do.

Under the proposed plan, Medicaid would also review hospital records after a patient’s third day at a hospital, rather than after the fourth day, as it does now. The reviews would be aimed at helping hospitals facilitate the transfer of patients to nursing homes and rehabilitation facilities, when appropriate, which would save money, said Tom Shanahan, spokesman for the Department of Health and Welfare.

St. Luke’s is already managing its length of stays, which averaged 2.6 days last year, George said. So, a review after three days "would not impact us in a significant way."

Sixty-five percent of the residents at Blaine Manor, the county’s only skilled-care nursing home, are on Medicaid, said Gail Goglia, the home’s director.

The home gets prescriptions filled for its residents and residents typically stay for more than four days, so they should not be directly impacted, Goglia said.

However, Medicaid reimbursements have been slowly declining from a rate of $152 per day for each recipient two years ago to a rate of $133.75 today, she said. The average cost each day of keeping a resident is $240.

Medicaid reimbursement "is a big issue for everyone that takes care of people in nursing homes," she said.

Health and Welfare and the governor would also extend the Healthy Connections program to most of the state’s 130,000 Medicaid recipients. Healthy Connections works at strengthening the doctor-patient bond allowing doctors to treat problems before they result in costly emergency-room visits.

"A lot of these people are not used to having regular medical care, so they wait until they’re really sick," before seeing a doctor, said Shanahan.

Healthy Connections does not operate in Blaine County, said Sue Harvey, a Health and Welfare employee who has been working to expand the program in South Central Idaho.

"If we enact these measures now, we will reduce what would have been more than a $30 million increase (in Medicaid’s 2003 budget) to a more manageable $15 million increase," Kempthorne said. "If we do nothing, we will see costs continue to spiral out of control."

"We’re not trying to cut services, what we’re trying to do is keep an eye on" expenses, said Shanahan.

But Blaine Manor’s Goglia, is skeptical.

"They’re right when the say they’re changing the way Medicaid is managed, but the result would be some cuts in some programs," she said.

The Idaho Health Care Association, which focuses on nursing home issues, expects Legislators to cut Medicaid even further this winter. So does Rep. Wendy Jaquet, D-Ketchum.

She said there is already talk among some legislators of eliminating Medicaid’s women and children’s program for prenatal and infant care.

"As we get down toward looking at changes in Medicaid, there’s going to be a lot of screaming out of the public. And I think that there’s going to be an opportunity to re-evaluate programs," said Rep. Tom Loertscher, R-Iona, Chairman of the House Health and Welfare Committee. "Whether or not we’ll have the courage to do the things we need to do, I’m not sure."

Jaquet is concerned that the proposed changes will fail at saving the targeted $15 million, which would mean a shortfall in the state’s overall budget.

Representatives at Blaine Manor and St. Luke’s emphasized that the plan is only a proposal and could change drastically as it makes its way through the state Legislature this winter.

The Joint Finance-Appropriations Committee must approve the plan, which could happen in the next few weeks, before the plan goes before the House and Senate for final consideration.

The changes would be aimed at slowing Medicaid’s rate of growth, which has been 16 to 25 percent over the last two years, to 6 percent in the coming year, Kempthorne said.

The governor, facing the worst state budget crisis in 18 years, earlier this month ordered reductions averaging 10 percent for all agencies, except for Medicaid, corrections, public schools and veterans.


The Idaho Mountain Express is distributed free to residents and guests throughout the Sun Valley, Idaho resort area community. Subscribers to the Idaho Mountain Express will read these stories and others in this week's issue.