Author:
Aaron Szydlo. M.H.A. Student. Saint Joseph’s College
Medicaid Budgeting in Long-Term Care
Since its inception in 1965, Medicaid has been at the forefront of healthcare discussions. Stemming from coverage of the aggregate groups who qualify, to financing the vast expanding services, Medicaid has been reformed over ten times (CHCS, P.1)1 While it is currently the largest insurance provider in the country, if the coverage and expansion continue at its current rate, it is my contention that it will not be sustainable. With the extension of coverage, it seems to be moving in the direction of universal medical care. Working in a Skilled Nursing Facility, I see the firsthand impact of Medicaid budgeting and its ramifications on long term residents.
Medicaid’s original intent was to cover only those who required cash assistance. However, since its inception, Medicaid has pivoted to cover children, pregnant women, the disabled, as well as long-term care2. Since 1965, Medicaid spending has jumped from under half a billion to $257 billion3. Specifically, in the long-term care sector, Medicaid is unable to meet the demand of those it covers. In addition, with an increasing elderly population, larger than any time in history, Medicaid is always playing catchup. Thus, we witness the evolution of MCO’s, Affordable Care Act, Home Care Based Services, and DRSIP programs.
While these and other programs are noble in virtue, few of them have had success. MCOs and the ACA have increased expenditures by adding administrative costs while simultaneously disincentivizing the necessary quality of care by focusing on cost cutting4. In addition, the ACA was introduced as friendly to those who did not want to lose their providers or current insurance, while millions found out that was not the case. Moreover, programs such as Delivery System Reform Incentive Payment (DSRIP), which aims to increase provider relations and reduce Medicaid expenses by 25% in 5 years, have been unsuccessful to date. Little evidence exists that DSRIP waivers have significantly improved quality and health outcomes or reduced spending on health care services5.
I believe that if Medicaid were focused on guaranteed cost-saving approaches instead of pouring money into bold ideas that are questionable, we would see true reform. In addition, I think Medicaid should redact the number of people it covers as that was never its intent. Lastly, in efforts to reduce the costs of Medicaid for long-term care, I think Medicare should cover more than 100 days in a SNF.
About the Author:
With a background in Business Management & Public Health, Aaron Szydlo administers several Medical Model Adult Day Care Centers throughout New York. In addition, he is completing his M.H.A. degree with Saint Joseph’s College / Maine. This blog post was adapted from his graduate “Gerontology” research.
References
1. Weil, A. (2003). There’s Something About Medicaid. Health Affairs, 22(1), 13-30. doi: 10.1377/hlthaff.22.1.13
2. History | CMS. (2020). Retrieved 17 May 2020, from https://www.cms.gov/About-CMS/Agency-Information/History
3. Weil, A. (2003). There’s Something About Medicaid. Health Affairs, 22(1), 13-30. doi: 10.1377/hlthaff.22.1.13
4. Manchikanti L, e., Helm, S., Benyamin, R., & Hirsch, J. (2017). A Critical Analysis of Obamacare: Affordable Care or Insurance for Many and Coverage for Few? - PubMed - NCBI. Retrieved 17 May 2020, from https://www.ncbi.nlm.nih.gov/pubmed/28339427
5. Gusmano, M., & Thompson, F. (2018). Medicaid Delivery System Reform Incentive Payments: Where Do We Stand? | Health Affairs. Retrieved 17 May 2020, from https://www.healthaffairs.org/do/10.1377/hblog20180920.103967/full/
