Medicare Compliance & Reimbursement

In search of Medicaid revisions to enhance the program and save cash, House Energy and Commerce Committee Chair Billy Tauzin (R-LA) has appointed a task force on the issue. The task force's goals, according to a press release: identify reforms to improve the health of low-income people; find ways to cut waste and fraud; and recommend revisions to "ensure long-term fiscal viability."

Tauzin suggested earlier this year that Commerce's primary goal on Medicaid might be to tighten up programs such as disproportionate share hospital payments that some legislators believe are widely abused by states to gain federal funds outside the spirit - if arguably within the letter - of the law. So far, the sole hearing in a promised Commerce series highlighted the Bush administration's proposal to cap some federal funding in exchange for more state flexibility to shape Medicaid, leading to speculation that Tauzin might aim to enact legislation embodying the president's plan.

But the makeup of the panel that Tauzin has just seated suggests that whatever legislation, if any, eventually emerges this year might be less oriented toward cutting back Medicaid spending than many had expected. The group is generally conservative but most also have backed efforts to get more federal dollars for their states.

Chairing the group is Rep. Heather Wilson (R-NM). In the last Congress, Wilson sponsored bipartisan legislation to permit states with low DSH payments to increase those allotments to 3 percent of Medicaid spending.

Rep. Ed Whitfield (R-KY) also sponsored bipartisan Medicaid legislation in the last Congress. Among other things, his bill would have permitted each state's DSH program to grow at the rate of inflation. Another panelist, Rep. Nathan Deal (R-GA), sponsored bipartisan legislation in the 107th Congress that sought to delay federal rules to phase out the so-called upper payment limit mechanisms states used to gain additional federal matching funds.

A fifth member, Rep. Mary Bono (R-CA), said in a recent statement that she decided to support the fiscal year 2004 budget resolution only "after receiving a personal pledge from Chairman [Jim] Nussle [(R-IA)] to restore proposed cuts to Medicaid in the final version of the bill ... preventing a loss of access to critical health care by those who need it most in this country."

The clearest Medicaid fiscal-hawk on the task force is the sixth and final member, Rep. Ernie Fletcher (R-KY), a physician who won his party's support May 20 as its nominee for the November governor's race. Recently, Fletcher has stressed his support for allowing disabled people to make more of their own choices about their Medicaid care. But he's also on record as a Medicaid skeptic.

For example, regarding proposals to expand insurance coverage by allowing more people to access Medicaid, Fletcher told the American Society of Interventional Pain Physicians in October 2001 that "I don't think most of us want to see more Medicaid in this country. ... Medicaid hasn't been the best system sometimes provided. ... You provide very rich benefits to folks on the low end, yet folks that are in the low-income working group get nothing."

Tauzin hopes to resume his Medicaid hearing series in mid-June.