Earlier this week, I wrote about the need for state-level flexibility in implementing Medicaid. I focused on the big picture—enrollment and eligibility standards and how they compare with federally mandated requirements—but as the following anecdote from Utah's governor suggests, states are constrained in what have to be incredibly frustrating ways even when it comes to what ought to be minor, easy-to-adjust operational details:
Utah officials waited for eight months to find out if the state would be allowed to use e-mail rather than paper to communicate with Medicaid recipients and save $6 million a year, he said.
"They sent us a denial by e-mail," [Utah's Republican Governor Gary] Herbert said. "The irony is rich." The state is continuing to pursue that Medicaid waiver and several others.
I'm not sure which is more absurd: That HHS said no, or that Utah had to ask in the first place. It's not particularly surprising, though, given the administration's overall track record on the issue. Health and Human Services Secretary Kathleen Sebelius sent states a letter earlier this month suggesting ways they could make Medicaid more efficient and less costly. But the administration's position on the matter essentially comes down to "don't make cuts; instead, do more with less." That's just not a workable solution. As Indiana's Republican Governor Mitch Daniels told a group of health reporters last week, the best practices suggested by HHS are "meaningless…people already copy each other. We don't need HHS's help to do it."
(Via PRI's John Graham.)