Life Sciences

Access to meds difficult for Medicaid

Medicare & Reimbursement Advisor Weekly, July 15, 2009

Medicaid’s cumbersome policies often lead to patients not getting or filling their prescriptions, receiving important diagnostic tests, or managing their chronic diseases, which will lead to more costs down the road, according to a new report released by the Association for Community Affiliated Plans (

Under current practice, the report estimates, Medicaid will cover 68 million people during the course of this year, but 13 million will not be enrolled in any given month mainly because their eligibility expired and they did not have a chance or the means to renew it. That results in lowered payments from the state and federal government to the providers and plans, whose officials say that getting those people eventually re-enrolled becomes an even bigger administrative and costly headache.

Officials from several health plans say creating policies that provoke churning is a common practice in states that are trying to reduce costs.

“States use the redetermination process to save money in times of tight budgets,” says Elaine Batchlor, MD, chief medical officer at LA Care, a Medicaid plan with 750,000 members. “They tend to increase the frequency of redetermination; that’s one way to decrease the number of people covered.” Direct medical home model offers healthcare without insurers

An insurance-free primary care “direct medical home” that requires patients to pay low monthly fees, but gives them 24/7 access and cheaper healthcare costs, has the potential to save hundreds of billions of dollars if it’s included in the national healthcare reform model, one advocate says (

Benefits consulting study on HMOs

Increases in healthcare costs for consumers aren’t likely to slow in 2010, with HMO rates projected to jump nearly 12%, according to a new study by benefits consulting firm Hewitt Associates. Although the study looks only at HMOs, it provides a snapshot at where companies are in negotiating 2010 rates with insurers (