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Front Page » May 5, 2011 » Opinion » Guest Column: Medicaid legislation solves problems
Published 1,245 days ago

Guest Column: Medicaid legislation solves problems


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By CHUCK GATES
Contributing writer

Kelly Holt wants a red jacket.

Like the one her younger sister, Karen, has already earned. One signifying that she's attained a coveted level of sales as a beauty consultant for Mary Kay Cosmetics, which would directly translate to an increase in her personal cash flow.

What Holt has never wanted, nor asked for, is a handout, although her developmental disability does provide her with modest Medicare and Medicaid benefits making it easier for this unsinkable 48-year-old to lead the largely self-reliant lifestyle she's fashioned for herself.

Holt is currently living with her 44-year-old sister and helping care for their 79-year-old father, who is in poor health. She's been years on the waiting list for a Medicaid waiver to qualify to receive additional services, but doesn't see that changing anytime soon.

"There's always someone, I suppose, who is in greater need than me," she says.

Instead, Holt enthusiastically pursues work, sometimes juggling two jobs to pay the bills.

She greatly enjoyed the food service job she held for three years at the USU-College of Eastern Utah, until she became a victim of budget cuts. She was also fond of her job at a local fitness center, only to be let go last year, leading to her joining the Mary Kay team. But as anyone familiar with network marketing will attest, it's hardly easy money.

Not that Holt's life trajectory would ever be mistaken for anything resembling easy. She suffered brain damage during a complicated birth leaving her developmentally disabled, a condition further exacerbated when she developed a high fever during her first few days of life.

But she was a fighter and that indomitable spirit displayed as a newborn remains. A former chairwoman for the Utah Developmental Disabilities Council (UDDC) and active in multiple other related organizations, Holt is a fierce advocate for her fellow developmentally disabled, even appearing in a radio spot several years back to raise public awareness.

Now she's concerned how burgeoning Medicaid costs and exploding program enrollments, worsened by the economic downturn, are threatening Medicaid's financial underpinnings crucial to her and other developmentally disabled seeking more independent lives.

Holt is hopeful the seeds of Medicaid reform planted by Sen. Dan Liljenquist, R-Bountiful, during the recently completed session of the Utah Legislature can help restore equilibrium to Utah's listing Medicaid program.

"Kelly Holt is one of the reasons we need to get a handle on sky-high Medicaid cost in Utah," Liljenquist says. "The safety net has too many holes. You'd have to say that the program, despite being wrapped in noble intentions, is out of control when those developmentally disabled that Medicaid is supposed to help - like Ms. Holt -- are facing the long-term threat of diminishing services because the funding pie is now being sliced and re-sliced into too many pieces."

So many of the developmentally disabled need Medicaid to lead their lives," says Claire Mantonya, executive director UDDC, an advocacy group for the state's 4,600 developmentally disabled receiving community supports through Medicaid.

Medicaid is a joint federal and state√ā¬†entitlement program that helps qualifying low-income individuals or families pay for the costs associated with long-term medical and custodial care.

No qualifying applicant can be turned away and there is no cap on the number of participants.

Currently, House District 69, which covers most of Carbon County including Price, along with portions of Grand, Emery, Wayne, Garfield and all of San Juan Counties, has 91 clients receiving Medicaid-sponsored care through the state's Division of Services for People with Disabilities. Another 18, including Holt, are on the waiting list for services, according to a recent count by the Utah's Department of Health Service

Liljenquist fears Medicaid's costs know no bounds.

"Ten years ago, Medicaid required nine percent of the state's funds. This year Medicaid ate up 18 percent. By 2020 -- just nine years from now --36 percent of our budget will be directly allocated to Medicaid. It's like Pac-Man," the senator says.

"Medicaid's present growth rate is ravaging the state's available funds. Right now, 60 percent of the budget funds education. If that portion remains consistent through 2020, and we are committed to paying 36 percent to fund Medicaid at that time, then we are left with the remaining 4 percent of the state's budget to take care of everything else. Without speedy intervention, Utah is committing entitlement-aided suicide," warns the laser-focused legislator.

The current Medicaid framework is being challenged in other states as well. "For reasons of history, bureaucratic inertia, and politics, New York's Medicaid program is not administered in the most rational or cost-effective way," opined New York's Lt. Gov. Richard Ravitch on how his state's own Medicaid woes threaten its budget.

Furthermore, down the road, should President Obama's own healthcare reform package survives legal challenges, Liljenquist sees the situation as even more dire. He said forecasts indicate that by 2020, when all of the mandates for health care reform are implemented, Utah could find itself spending just under half of its annual budget on Medicaid funding.

Liljenquist's reform package sets in motion a process that will include hearings and reviews aimed at reining in Medicaid spending, including:

*Promoting "managed" or "bundled" costs over traditional open-ended "fee for services" payments.

*Capping Medicaid spending tied to state budget expenditures.

*Creation of a Medicaid-specific rainy day fund.

"By having care providers compensated on a per patient basis rather than on a fee-for-services method they and the system are incentivized toward greater efficiencies and will focus greater energy and resources on preventative medicine," Liljenquist said.

However, all of this is a non-starter without achieving the federal waiver to allow implementation of these critical changes. Fortunately, the senator notes, the prevailing attitude in Washington, D.C. shares similar panic for Medicaid's present trajectory.

"Without the waiver, we have nothing but extreme options left. In reality, the number we are looking at if the current course is sustained is somewhere between $500 million and one billion dollars in additional needed funding," the senator said. "Coming up with that sort of money will force us to take tremendous and somewhat unimaginable measures.

"We will either need to raise taxes substantially, lay off 20,000 school teachers, close down three of our universities, make extreme cuts to Medicaid rates or opt out of Medicaid entirely, as some other states are considering at this very minute. I am working hard to see that Medicaid can be preserved as the safety net for people like Kelly Holt who need the additional supports.

This isn't Liljenquist's first big-time fiscal rodeo, however.

A little over a year ago he was wading through the budgetary swamp looking for a way to escape the public pension quicksand that has trapped several fellow states.

The creative path mapped by Liljenquist and others in 2010 became landmark pension reform, substituting a 401(k)-style plan for new state and municipal government workers in place of defined contributions. Budget and political wonks around the nation have taken notice of Liljenquist's "Utah Model," including the Wall Street Journal and New York Times in recent months.

Perhaps with a little luck and by adopting good policy choices as part his reform package, Utahns can wake up from this current nightmare to a new round of news articles celebrating the senator and the state for saving both Medicaid and the patient.

While not a red Jacket, Holt says, that's something she would enjoy having very much too.

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