Obama Quietly Starting His Own Voucher Program

[mudwhistle]

Medicaid managed care isn't a voucher program.

I thought we were talking about a new Obama program?

Correct me if I'm wrong.

But if I'm remembering correctly there have been accusations that Ryan is wanting to push seniors into using vouchers.

Are you saying they're lying now?

Let's walk through this step-by-step.

Medicaid is a network of 51 state-operated health insurance programs (in every state and D.C.) that provides services to people that 1) fall into certain categories, and 2) meet certain income and asset requirements. Medicare is the fully federal health insurance program for people over 65 years old.

A state could let its Medicaid agency operate like a health insurance company, similar to how Medicare works. Then if a Medicaid beneficiary goes to a participating doctor/hospital, the state pays the doctor/hospital for any covered services rendered to the beneficiary, according to some set fee schedule established by the state. That's fee-for-service Medicaid and historically it's how Medicaid used to work and still does for some populations in some states.

But back in the '90s, states started experimenting with alternative approaches, using various waiver authorities that are built into the Social Security Act. These approaches are collectively known as Medicaid managed care. They started small but now a majority of Medicaid enrollees nationwide are in some form of Medicaid managed care. Two approaches are relevant here:

1. About half of Medicaid enrollees nationwide are enrolled in a private health plan. Their state Medicaid agency contracts with a private insurance company that agrees to offer Medicaid benefits to enrollees, doing all the insurance company stuff that the state then no longer has to worry about. The private health plan gets a fixed amount of money for each Medicaid beneficiary who joins their plan and that collective pot of money is what the insurer has to work with--this is called capitation.
   
2. Another slightly less common form of managed care states use is called primary care case management. In this arrangement Medicaid beneficiaries don't pick a private insurance company to manage their benefits. They pick a physician who gets paid fee-for-service by the state for services rendered, as well as an additional fee on top of that to coordinate/manage other services the patient may need.

MACPAC, the group created a few years ago to advise Congress on Medicaid, dedicated a whole Report to Congress last year on the evolution of managed care in Medicaid. You can read all about the ins and outs of it in there.

Now what's the issue at hand here?

There are 9 million people who are eligible for both Medicare and their state's Medicaid program. These older, poorer folks are known as dual eligibles or duals. These people basically have two health insurance plans, Medicaid and Medicare, that don't match up or work together particularly well. Which is bad, since this is a particularly sick, expensive population. By-and-large, this group is getting their medical services paid for fee-for-service. Again, that's tricky because they have two totally different health insurers (their state government and the federal government) paying their bills in a not-so-cohesive way.

That leads us to the subject of the thread, the "Financial Alignment Initiative" that was announced a year ago (which apparently has become news in the rightwing blogosphere this week for some reason), an idea to give states some options on better coordinating care and benefits for Medicaid enrollees who are also eligible for federal Medicare benefits.

And they're doing it using two forms of managed care, not dissimilar to what states are already doing with other populations:

1. One approach states can take is a capitated model: the state and the federal government can go in together to contract with a private health plan, that then 1) gets a capitated payment that blends the Medicaid and the Medicare funding to which the enrollee is entitled, and 2) offers the enrollee's Medicare and Medicaid benefits in one sleek, integrated package. This builds on approaches that are already in use in some places.
   
2. The other approach looks more like primary care case management, though it relies on more advanced models of primary care. The state gets federal money for the enrollee to use in funding a care model that, again, integrates Medicare and Medicaid benefits in a single special arrangement of health care providers.

These models are very similar to what states already do for other Medicaid populations (e.g. kids), except they have the added complexity of weaving in Medicare money and benefits. That's what new, special, and promising about what they're doing.

What the rightwing folks seem to be taking issue with here is the capitated model (which, again, is something that about half of everyone in Medicare is in right now). But that isn't a voucher system, even though private health plans manage the benefits. Capitation doesn't put Medicaid enrollees at risk, as the Medicaid program still pays for all Medicaid-covered benefits.

Voucher programs ala Romney-Ryan, on the other hand, are designed to put enrollees at risk precisely because screwing over enrollees is cheaper for the government. That's why people don't want to voucherize the public health insurance plans; instead of guaranteeing access to the benefits to which they're (until Romney-Ryan take power) entitled by law, they offer you some cash and wish you good luck in finding a health insurer offering a plan that meets your needs.

Medicaid managed care offers Medicaid beneficiaries all the benefits to which they're entitled and the Medicaid agency retains financial responsibility for those benefits, they just allow competing private plans to administer them under contract with the Medicaid program (and under this new approach for duals, under a three-way contract between Medicaid, the federal government, and the health plan). Medicaid beneficiaries in managed care states are not left out in the cold, nor are they asked to pay more because the Medicaid program feels like paying for less.

Or put more simply: vouchers are Romney-Ryan's way of getting the federal government out of its Medicare responsibilities, at the expense of seniors; Medicaid managed care is not an attempt by state Medicaid agencies to get out of their obligations to Medicaid beneficiaries.

Dude, your credibility is for shit.



Why don't you go back and report to whatever agency that hired you.

 

[Polk]

And it's almost exactly like the one Paul Ryan proposed.

So your point is???????

That's not even remotely like what Ryan proposed.

Sorry, but the article says otherwise.....so I'll trust the article over some schmuck blogger.

The "article" you're quoting from is a "schmuck blogger".

 

[Polk]

I thought we were talking about a new Obama program?

Correct me if I'm wrong.

But if I'm remembering correctly there have been accusations that Ryan is wanting to push seniors into using vouchers.

Are you saying they're lying now?

Let's walk through this step-by-step.

Medicaid is a network of 51 state-operated health insurance programs (in every state and D.C.) that provides services to people that 1) fall into certain categories, and 2) meet certain income and asset requirements. Medicare is the fully federal health insurance program for people over 65 years old.

A state could let its Medicaid agency operate like a health insurance company, similar to how Medicare works. Then if a Medicaid beneficiary goes to a participating doctor/hospital, the state pays the doctor/hospital for any covered services rendered to the beneficiary, according to some set fee schedule established by the state. That's fee-for-service Medicaid and historically it's how Medicaid used to work and still does for some populations in some states.

But back in the '90s, states started experimenting with alternative approaches, using various waiver authorities that are built into the Social Security Act. These approaches are collectively known as Medicaid managed care. They started small but now a majority of Medicaid enrollees nationwide are in some form of Medicaid managed care. Two approaches are relevant here:

1. About half of Medicaid enrollees nationwide are enrolled in a private health plan. Their state Medicaid agency contracts with a private insurance company that agrees to offer Medicaid benefits to enrollees, doing all the insurance company stuff that the state then no longer has to worry about. The private health plan gets a fixed amount of money for each Medicaid beneficiary who joins their plan and that collective pot of money is what the insurer has to work with--this is called capitation.
   
2. Another slightly less common form of managed care states use is called primary care case management. In this arrangement Medicaid beneficiaries don't pick a private insurance company to manage their benefits. They pick a physician who gets paid fee-for-service by the state for services rendered, as well as an additional fee on top of that to coordinate/manage other services the patient may need.

MACPAC, the group created a few years ago to advise Congress on Medicaid, dedicated a whole Report to Congress last year on the evolution of managed care in Medicaid. You can read all about the ins and outs of it in there.

Now what's the issue at hand here?

There are 9 million people who are eligible for both Medicare and their state's Medicaid program. These older, poorer folks are known as dual eligibles or duals. These people basically have two health insurance plans, Medicaid and Medicare, that don't match up or work together particularly well. Which is bad, since this is a particularly sick, expensive population. By-and-large, this group is getting their medical services paid for fee-for-service. Again, that's tricky because they have two totally different health insurers (their state government and the federal government) paying their bills in a not-so-cohesive way.

That leads us to the subject of the thread, the "Financial Alignment Initiative" that was announced a year ago (which apparently has become news in the rightwing blogosphere this week for some reason), an idea to give states some options on better coordinating care and benefits for Medicaid enrollees who are also eligible for federal Medicare benefits.

And they're doing it using two forms of managed care, not dissimilar to what states are already doing with other populations:

1. One approach states can take is a capitated model: the state and the federal government can go in together to contract with a private health plan, that then 1) gets a capitated payment that blends the Medicaid and the Medicare funding to which the enrollee is entitled, and 2) offers the enrollee's Medicare and Medicaid benefits in one sleek, integrated package. This builds on approaches that are already in use in some places.
   
2. The other approach looks more like primary care case management, though it relies on more advanced models of primary care. The state gets federal money for the enrollee to use in funding a care model that, again, integrates Medicare and Medicaid benefits in a single special arrangement of health care providers.

These models are very similar to what states already do for other Medicaid populations (e.g. kids), except they have the added complexity of weaving in Medicare money and benefits. That's what new, special, and promising about what they're doing.

What the rightwing folks seem to be taking issue with here is the capitated model (which, again, is something that about half of everyone in Medicare is in right now). But that isn't a voucher system, even though private health plans manage the benefits. Capitation doesn't put Medicaid enrollees at risk, as the Medicaid program still pays for all Medicaid-covered benefits.

Voucher programs ala Romney-Ryan, on the other hand, are designed to put enrollees at risk precisely because screwing over enrollees is cheaper for the government. That's why people don't want to voucherize the public health insurance plans; instead of guaranteeing access to the benefits to which they're (until Romney-Ryan take power) entitled by law, they offer you some cash and wish you good luck in finding a health insurer offering a plan that meets your needs.

Medicaid managed care offers Medicaid beneficiaries all the benefits to which they're entitled and the Medicaid agency retains financial responsibility for those benefits, they just allow competing private plans to administer them under contract with the Medicaid program (and under this new approach for duals, under a three-way contract between Medicaid, the federal government, and the health plan). Medicaid beneficiaries in managed care states are not left out in the cold, nor are they asked to pay more because the Medicaid program feels like paying for less.

Or put more simply: vouchers are Romney-Ryan's way of getting the federal government out of its Medicare responsibilities, at the expense of seniors; Medicaid managed care is not an attempt by state Medicaid agencies to get out of their obligations to Medicaid beneficiaries.

Dude, your credibility is for shit.



Why don't you go back and report to whatever agency that hired you.

He just explained exactly what the proposal is. Your claim that he's not credible, but that Dana Loesch is, says a lot more about you than it does about him.