Medicaid strains state budgets while continuing to suffer from problems of institutional bias, low reimbursement, access and quality. Yet, what does the problem of "access" mean?
If you are a regular reader of the weekly publications put out by my good friend and colleague Steve Moses of the Center for Long Term Care Reform, then you've heard the familiar refrain that Medicaid strains state budgets
while continuing to suffer from problems of institutional bias, low reimbursement, access and quality. Throughout the years, he's provided ample evidence backing up each one of these allegations such that the argument has long since been won.
However, when he speaks of "access,” what does he mean? I think the term can be a little bit "high-concept,” yet it's important that we as producers are able to really appreciate its significance and be able to explain it to our prospects.
We have a tendency to gloss over Medicaid, but it would be better if you thought of it as the "elephant in the room." As the country's "de facto" long term care insurance company, it's the product most of your prospects are already planning on "buying" if your sales pitch isn't convincing enough.
When I find an article that illustrates what Medicaid's lack of access looks like, I seize it. I found one recently on Politico.com, and it can be summed up by the popular expression, "Money talks, bull$%@ walks." That's the gist of it.
If you imagine a healthcare system divided into private-pay ($$$) and public-pay (¢¢¢), it won't take long to imagine the ramifications. Since Medicaid reimburses nursing facilities
approximately $10 per day less than it costs to provide care, how available are beds going to be for Medicaid patients? Plenty or scarce? What if you walked in with your pockets full of insurance money? "Step right up — may we show you to your room?"
Did you know that several New Hampshire
chains are now switching entirely to private-pay? Yup. What about assisted living? If you don't have insurance, forget it. No access. Medicaid
pays for hardly any assisted living.
What about home health care? Sure, a lot of states make noise about their new home- and community-based options (designed to save money¹), but with 5,000 people trying to get 500 slots, you're literally in a raffle. That's an access problem.
So with that in mind, I introduce you to an article from December, entitled "The Dangers of the Medicaid Illusion
," by Rep. Bill Cassidy, R-LA. Although he writes about hospitals, I trust you can make the intellectual leap to long term care. The analogy is the same. As he summarizes, "My Medicaid patients do not choose Earl K. Long Hospital. Medicaid chooses Earl K. Long for them, because it does not provide access to healthcare anywhere else."
I couldn't have said it better myself!
¹ These are interesting to keep an eye on, because year after year, they introduce the “community first” programs, then the next they de-fund them, then back again. The cycle continues. There's a prevailing belief that re-balancing saves money because home care must be less expensive, but experience has proven it isn't, and the programs get scaled back.