In the wake of the denial of a Medicaid waiver by President Barack Obama’s health care regulators, Oklahoma policymakers are considering pursuing market-oriented reforms of their Medicaid program, changes that have previously secured federal waivers for three other states from administrators in Washington.
In each of those states—Florida, Louisiana, and Kansas—market forces are being used to improve medical care for Medicaid recipients, at lower costs to taxpayers, according to Florida’s Foundation for Government Accountability (FGA).
Although the Centers for Medicare and Medicaid Services (CMS) recently denied the long-running Oklahoma Medicaid waiver which supported the Insure Oklahoma program for the working poor, some legislators are hopeful about using this approach to pursue future flexibility given the fact CMS has approved other states’ implementation of these options.
With the help of the Oklahoma Council of Public Affairs (OCPA), FGA organized a seminar for Oklahoma legislators to highlight reforms in the Sunshine State, branded as the “Medicaid Cure.” Among the more than two dozen legislators in attendance were state Sen. A. J. Griffin, R-Guthrie, a cosponsor of a measure which would pursue this approach in Oklahoma.
Changing How Medicaid Works
The star of the state Capitol seminar was Moises Brutus, now a college student in Florida, who lost both legs and part of his left arm in a 2010 motorcycle accident. He endured months of frustration when his recovery was supervised by what he described as “Old Medicaid.
The triple-amputee encouraged legislators to create an Oklahoma version of what is called a new Medicaid model.
“The government helped me get on my feet, yes,” Brutus told lawmakers in the Sooner State. “To me, the object is to move away from, to get off, government dependency.”
He continued, “There are others like me who can’t better themselves within the systems where there is no flexibility. I think the idea is to get people to a point of caring for themselves.”
He told the Oklahomans he is now at that point.
Traditional Medicaid Failed
Brutus, the subject of a five-minute video posted online, recalled traditional Medicaid “kept giving me bad prosthetics, and those kept breaking.”
When his case was transferred to WellCare, part of the Medicaid Cure pilot program in Florida, things changed for the better.
His care administrator, Catherine Martinez, transformed his therapy and health regimen. “They got the prosthetic right in the first place,” he said.
Pivotal to Medicaid Cure, Brutus and other proponents contend, is that patients (consumers) can choose among competing managed care businesses. Brutus believes his change in fortune was driven by the difference between a “one-size-fits-none” mindset and the dynamic, competitive approach available in Florida’s Medicaid Cure.
Regarding defenders of standard or “Old Medicaid,” Brutus stated, “from my point of view it hasn’t worked, and it’s not going to work. So it’s time to try something new. I’m going to school, then I’m going to get a job, then I’m going to pay taxes.
“I’m already giving back with involvement in bicycle races to support this cause. I see myself, in five years, having the horizon open to me,” Brutus added. “Whatever happens in my life will be good. Who knew this could turn out so well for me?”
Significant Savings for State
FGA arranged Brutus’ visit to Oklahoma. The group has described traditional Medicaid structures as embodying a top-down “pay and chase” structure (i.e. pay claims, chase fraud) without the discipline of market competitiveness among providers.
Tarren Bragdon, FGA’s president, said the Florida pilot program, which began in 2005 under former Gov. Jeb Bush, incorporates choice, customized benefits, incentives for health rather than the convenience of providers, and accountability for all actors in the system—including plans, providers, and patients.
Spending in those Medicaid Cure counties runs nearly $700 per person less than in the state’s traditional Medicaid programs, Bragdon reports. Florida officials estimate $118 million in system-wide savings have already been achieved, and projects that more than $900 million a year could be saved when the reform model is expanded statewide.
Maddie McAndrew, administrator of Louisiana’s Bayou Health program patterned on the Florida reforms, agreed with Bragdon about the reform representing a path to more savings and better outcomes for states. But McAndrew said the early transition away from traditional Medicaid, which began just over a year ago, was challenging.
“It was chaos, but now it’s working,” McAndrew said.
“Our emphasis has included risk adjustments for each recipient” McAndrew said. The program is succeeding, as it did in the Florida program, because administrators have listened “to the stakeholders—the patients, the providers,” she added.
Issue for Future Legislatures
The managed-care programs in Florida, Louisiana, and Kansas, focused on Medicaid-eligible populations, are the basis for Griffin’s proposal, introduced as House Bill 1552 in the Oklahoma Legislature.
Insurance programs in the envisioned Oklahoma system would include long-term care, allowing some distinctions between urban and rural care systems. Although the legislation will not advance in this year’s legislative session, Griffin says it remains a “live round” and could provide a vehicle for changes to Oklahoma’s system in 2014.
Patrick B. McGuigan ([email protected]) is Oklahoma City bureau chief for Watchdog.org.
The Medicaid Cure: “Moises Brutus: Never Give Up,” September 2012.