For all that President Trump loves to portray himself as a protector of American medical care, witness his new and tired claim to have “Pre-existing conditions saved in your medical care“When you have actually undermined those safeguards, perhaps the most consistent administration health care policy has been an attack on Medicaid.
The new year brings the opening of a new front in this war against the government program aimed specifically at providing coverage to low-income households. The White House says it plans to tighten Medicaid eligibility rules.
It is a process that, according to experts, is likely to increase administrative costs for states, reduce the funds available for medical treatment and expel millions of people from the program, even if they are eligible.
We have not seen convincing data that there is widespread eligibility fraud.
Joan Alker, Georgetown University
It is also happening despite the absence of credible evidence that the eligibility rules have been abused.
“We have not seen any convincing information that there is widespread eligibility fraud,” says Joan Alker, a leading Medicaid advocate as executive director of the Center for Children and Families at Georgetown University.
However, the momentum of the administration for a stricter monitoring of eligibility has put the nervous states that they are about to carry burdensome new bureaucratic responsibilities.
State Medicaid officials recognize that in a program that covers more than 71 million people across the country, some members may not meet all economic and categorical requirements.
But “we don’t see the kind of things that fall from the sky,” says Matt Salo, executive director of the National Association. of Medicaid directors. The concern of its members, he says, is that the administration will propose “a laser-guided mouse trap for a mouse.”
We have reported earlier on the hostility shown by the Trump administration, and political conservatives in general, by Medicaid.
Based in part on the encouragement shown by conservatives to any program specifically dedicated to low-income residents, it increased considerably after the Low Price Health Care Act allowed states to expand Medicaid eligibility beyond the population Traditional low-income families with children to include low-income children adults
This has led to a relentless attack on seemingly “work-fit” Medicaid recipients, who are generally represented as simulators and criminals who absorb precious dollars of medical care that should go to traditional recipients.
Typical of this line was the false claim that Ohio had expelled 34,000 disabled people from their Medicaid rolls to accommodate the disabled, sold by right-wing expert Ben Domenech in the CBS news program “Face the Nation” as moderator , the obviously uninformed and selfless John Dickerson, sat quietly next to him.
Unfortunately, the banner carrier for the campaign against Medicaid has been Seema Verma, who as administrator of the Centers for Medicare and Medicaid Services (CMS) in the Department of Human and Health Services should protect the program, not undermine it.
Verma has happily promoted the “fit for healthy people” coup and has been at the forefront of the push to impose work requirements on Medicaid beneficiaries, a policy that has been shown to no longer provide medical care to the target population, does not reduce Unemployment and has been declared illegal.
As expected, Verma has also been at the forefront of the eligibility issue. In a November speech to the group of Medicaid directors in November, he said that “lax eligibility practices jeopardize the sustainability of the program” and hinted that his agency had compiled “deeply worrying” figures about the enrollment of ineligible people.
Although he did not produce the figures and acknowledged that the CMS survey had covered only one third of the states, he said the review had “identified deficiencies” and added: “That sound you hear is the shriek of the canary in coal.” mine.”
Verma justified his concern by stating that Medicaid represents 30% of state budgets. In other words, their goal was to protect the taxpayers of the states, not just the federal ones.
As it happens, this is a completely false and highly dishonest statistic. Treat the amount the federal government pays for this federal-state program as if it were state money. That amounts to counting twice, since Medicaid is the largest source of federal dollars that flows to the states, as Salo observes.
The actual proportion of non-federal state funds dedicated to Medicaid, according to the federal government’s own figures, is approximately 16%. Since one of the main duties of the government is to keep their populations more vulnerable, does that sound excessive?
Shortly after Verma’s speech, CMS published a 300-page report on financial measures, which shows an undue payment rate of 8.36% based on eligibility. But a careful reading showed that the vast majority of these cases were considered inappropriate due to bureaucratic technicalities, not fraud.
Less than one tenth of the undue payments were related to patients who “were determined not to be eligible for Medicaid or the benefit provided,” as reported by Kelly Whitener of the Georgetown Health Policy Institute.
In other words, the actual rate of inadequate eligibility is less than 0.83%, at best. In any case, total enrollment in Medicaid has been declining, reaching 71.4 million in the third quarter of 2019, from a peak after the ACA of 75.1 million in early 2016. (The monthly average before the ACA was approximately 56.5 million).
The CMS report generated overheated responses to the right, none more inflamed than an opinion piece in the Wall Street Journal by a former Trump administration advisor and a member of the Cato Institute. They claimed that, according to their own “new research, … between 2.3 million and 3.3 million people with incomes above the eligibility thresholds … are enrolled in Medicaid in states of expansion.”
They wrote that “there are some areas, such as New York City and Los Angeles, where the problem seems so great that it suggests intentional and fraudulent abuse by local officials and the medical industry.”
I have asked the co-authors to provide data or documentation for this highly successful claim, and I will update it here if I receive it.
What is really behind the eligibility campaign? Alker sees it as part of a broader campaign “designed to reinforce negative stereotypes about Medicaid beneficiaries” and a means to make states nervous about spending on the program. It is a phenomenon that probably prompts some states to reduce their share of Medicaid.
What is lost in this discussion is how crucial Medicaid has become for American families at the lower end of the economic scale. The program now pays approximately half of all births in the United States (more than 60% across the south, which remains a nest of anti-expansionism). It covers 62% of all residents of nursing homes and is the largest source of payment for mental health services.
“We cover all these things because nobody else wants,” says Salo.
Under the circumstances, shouldn’t the administration have better support for its claim that eligibility fraud is a problem than false numbers and ideological animosity?