Medicaid, budgets and patients part three: Patients at risk

Medicaid is an essential program for millions of Americans.

This week, we are taking a look at proposals in several states that would change the way they administer the pharmacy benefit in their Medicaid programs – transitioning from traditional fee-for-service Medicaid to a managed care model. Today we look at how these changes could impact patients who already are at risk. Earlier posts in the series can be found here and here.

Medicaid is an essential program for millions of Americans who do not have private health insurance.

How essential? Consider a study of the Oregon Medicaid program that found:

  • One year after the enrollment, those receiving Medicaid benefits reported they had received 30 percent more hospital care than their uninsured counterparts, in addition to 35 percent more outpatient care and 15 percent more prescription drug care.
  • Medicaid patients were 70 percent more likely to find a regular doctor.
  • Insurance coverage decreased the probability of having a bill sent to a collection agency by 25 percent, out-of-pocket medical expenses by 35 percent and the need to borrow money or skip other bills by 40 percent.

Given the importance of Medicaid to these patients, they should have the same medical options available as elected officials and other public employees – and decisions about their care should be left to their doctors, as we noted yesterday. Otherwise, those at risk will suffer most.

In many cases, doctors may not have full treatment options for vulnerable patients if states substitute government’s medical judgment for that of medical professionals.

Without patient protections, a patient’s choice will be to either use a medicine that the doctor and patient already know is ineffective – or submit confusing paperwork and wade through a bureaucratic government process to get the care that their physician recommends.

Doctors must be allowed to give the care that they judge to be most effective.  Including patient protections in managed care Medicaid plans is a simple step to protect patient health while saving money and time for all involved.

Tomorrow, we will take a look at what protections we believe should be included for patients.