Medicare Compliance & Reimbursement

The National Governors Association task force on Medicaid is a long way from consensus on program revisions to recommend, according to evidence that emerged from a May 14 Washington meeting of the group.

A document apparently presented by some governors for consideration at that meeting made the rounds in Washington last week and revealed a lack of consensus on key matters even among the group that supported the document. The proposal, which in broad outlines echoes the Bush administration's plan for Medicaid, also differs from the White House plan in some ways that would seem to make it a non-starter with the administration.

The proposal recommends capping federal Medicaid expenditures, as the White House wants, but also aims at making the plan more state-friendly by establishing caps on a state-by-state basis and basing them on actual cost-trend factors "calculated after each year is complete and actual ... factors are known." The governors also would let states opt in to the program at any time, not just in the first year as the White House proposes, another change that would make federal costs much more unpredictable.

In a more White House-friendly provision, the proposal would make states fully responsible for any new services they chose to offer, including to mandatory populations.

Despite being labeled "final draft," the proposal has some glaring omissions of detail. Under the heading, "issues still to be resolved," the document lists these: whether the federal government should take over costs for people dually eligible for Medicare and Medicaid; which base year would be used for the capped program; and how disproportionate share hospital payments, intergovernmental transfers of funds, and the State Children's Health Insurance Program would be handled in a transformed Medicaid.

Meanwhile, a promised hearing series on Medicaid at the House Committee on Energy and Commerce still hasn't made it onto the panel's official schedule, although a spokesperson notes that the committee only places hearings on its schedule one week in advance.

A general queue of 2003 issues has been set up, though, according to the spokesperson. In the health arena, now that Commerce has completed work on the so-called BioShield initiative, the panel will take up Medicare revisions and a prescription-drug benefit. Discussions of Medicaid will wait until the Medicare debate is completed and therefore likely won't take place until midsummer or later.