Is the Obama Administration Giving States Flexibility When It Rejects Proposals to Reduce Medicaid Costs?


The Obama administration frequently refers to the state-level "flexibility" it gives states to manage their own health systems; its proposed rules governing ObamaCare's state based health exchanges employs the word 38 times. But that flexibility is often a mirage, especially when it comes to the single biggest state budget item: Medicaid. 

When states complain about not having flexibility to manage their Medicaid programs as they'd like, this is the sort of thing they're talking about. Via Kaiser Health News:

The Obama administration has rejected Hawaii's proposal to limit most adult Medicaid recipients to 10 days of hospital coverage per year, which would have been the strictest in the nation.

Instead, Hawaii has been approved to implement a 30-day hospital coverage limit starting July 1, state and federal health officials say. Exempted from the limit are children, pregnant women, those undergoing cancer treatment, the elderly and the blind and disabled.

The Centers for Medicare and Medicaid Services is still mulling aproposal from Arizona last September to limit adult Medicaid patients to 25 days of hospital coverage  a year.

It's also why converting Medicaid's system of federal matching dollars, which encourages states to ratchet up spending by giving them roughly a dollar of federal money for every home state dollar they put toward the program, to a block grant program paired with increased state-level authority over their own Medicaid programs seems like such a no brainer. Rather than making spending increases easy and reductions painful, as the matching dollars system does, block grants would give states a predetermined amount of federal funding and then encourage them to experiment with the best ways to use that money. Right now, though, even the most basic attempts at experimentation have to wait endlessly for federal approval and many are rejected. 

Here's my 2011 take on block granting and the Medicaid mess in The Wall Street Journal

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  1. palin’s death panels do exist at state level! bloody 10th amendment

    1. But the feds would never do that. Palin was dead on correct. And that is why the left went apeshit. Of course when they happen the line your ilk will be “everyone always knew these things coming, nothing to see here”

      1. jan brewer runs a death panel & she aint “the left”…unless by teh left u mean skeletor.

        1. “unless by teh left you mean skeletor.”

          Slade Gorton?

  2. I prefer the Beach Boys’ version of “I Can Hear Music” to the original. Specter stuff came naturally to them. The Five-O theme sounds like it was performed by Chicago.

    1. *Spector. Freudian slip.

    2. You are right about “I Can Hear Music”. But the Ventures do not sound like Chicago. Chicago never had a drummer like that.

      1. Maybe not, but don’t discount the early Chicago. Those guys had chops before fucking Cetera turned them into easy-listening shit rock.

  3. Of course, Hawaii is going at it from the wrong end: they are reducing payments to providers, which, under Medicaid, are already far short of the actual out-of-pocket cost to the provider of providing the care. This just results in more cost-shifting. See, also: Titanic, deck chairs, relocation of.

    If they really want to do this right, they need to cut benefits. But no politician has the guts to do that.

  4. Exempted from the limit are children, pregnant women, those undergoing cancer treatment, the elderly and the blind and disabled.

    How else do they have on medicaid?

    1. *Who*

    2. The unemployed… 🙁

    3. people who spend down and/or hide assets to qualify for long term care

  5. Telling states to “bend over” is ‘giving them flexibility’… Duh!

  6. This in a state that two years ago killed off their SCHIP program when privately insured children became eligible and enrolled in droves; HI had to kill it off six months later.

    Vote JW!


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