Tuesday, December 16, 2008

NC Medicaid recipients who own or buy their homes cannot get access to dependable Medicaid & have increases in hospitalization

IN NC, Medicaid eligibility is re-determined every 6 months for people who utilize a deductible to get to Medicaid (which can then pay a healthy portion of their back medical bills).

If the state wants to save money as associated w/ increased rates of hospitalization of these people, then dependable Medicaid seems to be associated w/ more outpt services and less hospitalization-----which costs more money.

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I have a client in western NC, Haywood county, whose husband is retired and he receives middle class level retirement benefits from his years of factory work. They are buying their house. They own a car. She cannot get dependable access to Medicaid in NC. Why? Because there is too much income coming into the household, approx $20,000/ year. She was not able to work during her child-bearing years because she had three chronically ill children. Thus, she was not able to vest in Social Security.

Haywood County DSS has advised her that if she wants to 'crank' her Medicaid, she has to do into the hospital on a particular day of the month. Then her Medicaid kicks in for 6 months, pays the big hospital bill, pays for her medications, some of which are cardiac, and then drops off again.

Then she has to accumulate MORE medical bills in order to apply the deductible against the sum of money coming into the household. Its usually about $6-10,000 of medical bills----in terms of what can be applied against the household income----that will allow Medicaid to kick in for 6 months.

This has gone on for years. She has had many hospitalizations which were not necessary in order to crank Medicaid.

This is silly. And it is a bad usage of NC tax $$$$$$.

Here is an article supporting the notion that states are spending more money as associated w/ hospitalizations when Medicaid comes and goes in spurts.

Wanna save money, NC? Then get smart about how Medicaid is utilized.

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(cut and paste): http://www.emaxhealth.com/1/72/27648/medicaid-insurance-coverage-interruptions-linked-increased-hospitalization.html

Medicaid insurance coverage interruptions linked to increased hospitalization

".....The study suggests that when states require enrollees to demonstrate eligibility on a more frequent basis, they may see an increase in hospitalizations for common health conditions: lacking insurance to cover the costs of primary care, many former Medicaid enrollees end up in hospitals and are then re-enrolled in Medicaid. The study of California adults, conducted by researchers at San Francisco General Hospital (SFGH) Medical Center and University of California San Francisco (UCSF), was supported by the Commonwealth Fund.

Federal rules require states to re-determine Medicaid beneficiary eligibility at least once every 12 months but some states do so more often. During most of the time of this study, 1998 to 2002, California - which has the largest Medicaid program in the U.S. - required beneficiaries to report on their eligibility every 3 months. California has since reduced the frequency of eligibility determination.

"Although states may attempt to save money in the short term by dropping Medicaid coverage for those who cannot keep up with frequent reporting requirements, this study shows that disruptions in coverage come at the risk of increased hospitalization for conditions that can typically be treated in a less expensive primary care setting," said lead author Andrew B. Bindman, M.D., a professor of medicine at UCSF and chief of general internal medicine at SFGH.

The analysis of Medicaid enrollment and hospital discharge data for more than four million California adults examines the number of Medicaid beneficiaries who experienced interrupted coverage and their hospitalization rates between 1998 and 2002.

During the study period, one in six Medicaid beneficiaries in the U.S. resided in California. More than 62% of eligible beneficiaries experienced interruptions in their Medicaid coverage during the study period, with an average interruption of 25 months.

The study authors recommend that states implement policies to reduce the frequency of interruptions in Medicaid coverage, to help prevent health events that require hospitalization and thereby reduce high-cost hospital spending...."

1 Comments:

Blogger Aftercancer said...

That is the spend down system that they use for adult Medicaid. It's crazy and has been like that for years. One way to work around that is also to have any case managers, nurses, therapy evaluations, etc all be performed the first few days of that 6 month period as well.

4:02 PM  

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