Medicare and medicaid
As published on page one of the April 6, 2011 edition of the Keene Sentinel, and online.
Republican leaders in the U.S. House unveiled a budget plan Tuesday that took aim at two of the biggest recipients of federal dollars: Medicare and Medicaid.
What are these programs -- with their confusingly similar names -- and how are they used here in the Monadnock Region?
Medicaid is insurance for people with low incomes. Recipients need to make less than a certain amount of money to qualify.
Think "financial (Medic)aid."
The federal government splits the cost of Medicaid with states, and states have some say in which groups of people get coverage, said Lisabritt L. Solsky, deputy Medicaid director at the N.H. Department of Health and Human Services.
In the Granite State, there is no Medicaid for healthy adults. The program is limited to those with low incomes who fall into certain other groups, including children, pregnant women, senior citizens and the disabled.
As of November, 8,170 people in Cheshire County were enrolled in the program -- about 10 percent of the population. More than 5,000 were children, and approximately 1,200 had physical or mental disabilities.
Unlike Medicaid, a person's income is not a factor in qualifying for Medicare, the federal insurance program for people over age 65.
Think "long-term (Medi)care."
In May 2010, 215,341 people in New Hampshire were enrolled in Medicare, according to the Kaiser Family Foundation. That's about 16 percent of the state population.
At Cheshire Medical Center/Dartmouth-Hitchcock Keene, 45 percent of the hospital's revenue comes from Medicare, according to Chief Financial Officer Jill I. Batty. Twenty percent of revenue comes from Blue Cross insurance, and 8 percent comes from Medicaid, she said.
The hospital bills the state for Medicaid and the federal government for Medicare in much the same way it bills private insurers, she said.
Statewide, Medicaid costs about $1.2 billion each year, according to Solsky. With 127,816 people enrolled, that comes to an average of more than $9,000 per covered individual per year.
The cost is split between the state and the federal government, and the federal government puts no limit on how much it will pay.
That would change under the proposal presented in the U.S. House on Tuesday. Under the block grant model proposed by House Budget Committee Chairman Paul Ryan, R-Wis., the state would get a fixed number of federal dollars.
This could mean passing on additional costs to the states unless other federal rules are changed, Solsky said.
Under the Affordable Care Act, the state is prohibited from changing its current Medicaid qualification criteria.
Because the state is committed to covering all eligible people -- "You can't do a waiting list on Medicaid," Solsky said -- the state's only way to cut costs in recent years has been to reduce the amount it pays to providers for services.
The state of New Hampshire is also looking at reducing the cost of Medicaid by moving to a managed care model, but it would take time before any reduction in cost would be felt from that switch, Solsky said.
Ryan's proposal also seeks to cap the government's obligation to Medicare by switching it to a voucher program for anyone under 55 years old.
Medicare recipients could choose from a variety of insurance providers, and the government voucher would cover a portion of the cost.
Batty, at Cheshire Medical Center, said it's too early to know what that could mean. But she speculated that having lots of Medicare agencies could end up driving up the overall cost of care by increasing the administrative burden on the hospital.
"It's very much easier for us to deal with a single large insurance provider," she said. "My guess would be that it would increase the complexity and therefore costs ... the hospital would have to pass those costs on to someone."
tagged with: explainer, federal budget, Medicaid, Medicare
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