MEDICAID 50 Years Old and Still Going Strong

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This week Congressman Elijah Cummings keynoted an event celebrating the fifty years of Medicaid in Maryland. Medicaid launched in Maryland in July of 1966. In 1966, Maryland Medicaid provided coverage for over 113,000 Marylanders. Today, approximately 1.2 million Marylanders receive health insurance coverage under Medicaid. 

The federal law that created Medicaid, The Social Security Amendments of 1965, was signed into law July 30th 1966 by President Lyndon Johnson. That legislation provided government-sponsored health insurance coverage for seniors, low-income children, caretaker relatives, the blind, and individuals with disabilities. Maryland was actually ahead of the Federal Government as the first state to adopt a medical assistance program administered outside of a welfare agency. For nearly 20 years prior to Medicaid’s passage, Maryland’s State-funded medical assistance program helped poor and elderly Marylanders gain access to health care. That Maryland fund would later be replaced by Medicaid after the federal legislation. 

Medicaid is our health safety network providing access to care to over a million Marylanders. MedChi works closely with the Department of Health and Mental Hygiene to protect and improve Medicaid. In order for Medicaid to remain strong and effective, MedChi thinks focus on three areas that require continued vigilance. These areas include ensuring that Medicaid patients have access to a physician, Healthchoice is funded and regulated properly, and that Maryland continues the tradition of innovation in delivering healthcare services. 

All Maryland Medicaid patients should have access to a physician. This need was seriously compromised when Medicaid reimbursement rates were reduced to 13% below Medicare reimbursement for all physicians for Evaluation and Management (E&M) codes. At the request of MedChi, 7% points have been returned to the payment over the last two years. Maryland physicians are now asking Governor Hogan and General Assembly leaders to finish the job, continue their good work, and restore Medicaid reimbursement to parity with Medicare. The question that we must ask is should people of lesser means receive the same benefit as seniors? Medicaid payment cuts to physician reimbursement create significant barriers to patient access and ultimately increases the cost of care as people seek treatment in more expensive locations like emergency rooms. The tremendous increase in Medicaid enrollment that has occurred with the implementation of federal health care reform makes retention of parity reimbursement essential. Maryland’s ability to maintain an adequate physician network and ensure patient access to necessary services is at risk if action isn’t taken. So the next question is, will Maryland’s 

leaders take up the challenge and put Medicaid in shape to meet the needs of Maryland citizens? 

As Medicaid continues to grow and expand, we need to make sure Healthchoice is properly funded and regulated. Healthchoice is the Maryland Medicaid mandatory managed care program that was approved by the General Assembly in 1997. HealthChoice features inclusive eligibility, statewide mandatory enrollment, risk-based purchasing, capitated rates, and service carve-outs, including mental health services. Roughly 80 percent of all Maryland Medicaid participants are enrolled in a HealthChoice Managed Care Organization. 

In order to make sure this major part of the Medicaid system works, we must continue a tradition of proper funding and regulatory protections for patients, physicians and the public health of Maryland. Unlike the private insurance market the Maryland Managed Care Organizations actually have competition as currently Maryland contracts with 8 MCOs to manage services under its HealthChoice. That competition is a positive for patients in Maryland. 

Finally, Maryland should continue its tradition of innovation and leadership in the area of Medicaid. One project that is currently being considered by DHMH displays that desire to continue to improve. The Maryland Medicaid Department is currently working on a possible dual eligible Accountable Care Organization (ACO) program. A duel eligible Medicaid patient is receiving both Medicare and Medicaid benefits. The focus on dual eligible was based on the consensus that was achieved through an Advisory Council and multiple workgroups that full duals should be a top priority as a population with substantial health and social support needs who are largely unmanaged in the current delivery system. One barrier to innovation is a long out dated technology needs and data management systems. Once these improvements are made, the Maryland Medicaid Department will be able to consider even more improvements. 

As we look back at fifty years of innovation and service, it would be an extreme oversight to not mention the amazing staff at the Department of Health and Mental Hygiene who serve the citizens of Maryland and work to provide access to care to so many. Some of these dedicated public servants have worked to improve healthcare for the most vulnerable for decades, and should be honored and appreciated for their work. Their dedication is why I believe we will see continued positive improvements as we work together to protect and improve health care for all Marylanders. 

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