New Medicaid Changes in West Virginia and Kentucky May Affect Otolaryngology Practice

People of different political persuasions generally agree that the health care system in the United States is in deep trouble, but there is no consensus on how to fix it. Hoping to reduce health care expenditures, the Bush administration passed the Deficit Reduction Act (DRA) in 2005, which provides greater flexibility to states to tailor Medicaid benefit packages to their populations. Before passage of the DRA, states had to provide comprehensive health insurance coverage for all low-income participants in their states. Now West Virginia and Kentucky are in the process of becoming the first states to make changes based on the new flexibility that will alter the way Medicaid is delivered. ENToday spoke with Medicaid officials in the two states and with physicians about how these changes could affect otolaryngologists-head and neck surgeons.

Sharing Responsibility in West Virginia

West Virginia’s Medicaid redesign is based on the idea of shared responsibility for health care. Medicaid recipients will be asked to sign a member responsibility agreement stating that they will show up for their medical appointments or call and cancel in advance. Participants who sign the contract will be entitled to enhanced benefits, which can be used to obtain health benefits not included in the mandatory benefits plan. These changes will affect about 160,000 Medicaid beneficiaries, most of them parents of children served by Medicaid. Those who opt not to sign the contract or to honor it will receive only basic coverage that provides fewer benefits than in the past; however, the plan for basic coverage is still being developed.

Shannon Riley, spokesperson for the Bureau for Medicaid Services in West Virginia, believes that the membership responsibility agreement is a good change that will make members more responsible for their health care.

We want people to partner with us and we want all of our members to choose to sign the agreement, she said.

The theory behind the redesigned package is that it will result in long-term cost containment, rather than immediate cost-containment. People who are on Medicaid have obesity, heart disease, and diabetes, and we cannot approach this passively, she said. The newly designed Medicaid package should help members get the right screenings from the right clinic at the right time, Ms. Riley noted.

A new concept incorporated into West Virginia’s proposed redesign is a team approach that will provide overall health-care management for Medicaid participants and will prevent duplication of services.