Doctors like plan to restore anti-smoking meds, add dental care to MaineCare

Posted Dec. 11, 2012, at 6:58 p.m.
Last modified Dec. 12, 2012, at 5:01 a.m.

AUGUSTA, Maine — A nine-member task force charged with finding short- and long-term savings in the state’s Medicaid program drew praise Tuesday for its recommendations for long-term restructuring, restoring coverage for anti-smoking medications and adding dental benefits for patients who frequent the emergency room.

Hospital representatives, physicians, Medicaid patient advocates and others were reacting to a draft report from the state’s MaineCare Redesign Task Force, which was charged with finding $5.25 million in state Medicaid savings this budget year and recommending longer-range reforms. Maine’s Medicaid program, which provides health insurance for low-income residents, has consistently been subject to cost overruns and is facing a $100 million shortfall this budget year, which ends June 30, 2013.

The task force’s report fell short of its short-term savings target, coming up with $1.35 million of the $5.25 million sought. But health-care providers, patient advocates and others offered support for many of its recommendations Tuesday.

The state earlier this year eliminated most Medicaid coverage for anti-smoking prescription medications as part of a larger package of Medicaid reductions. The report’s recommendation to restore the coverage would cost about $530,000 annually, but advocates for the move touted the potential for even greater future savings.

“This is an area where we really ought to be investing in: getting as many people as possible to quit smoking, particularly when the research shows they’re interested in quitting,” said Ed Miller, vice president for public policy for the American Lung Association of the Northeast, who noted that 42 percent of Maine’s Medicaid recipients smoke, compared to 17 percent of non-Medicaid recipients.

Advocates for dentists and patients praised the recommendation to pay, at an annual cost of $3.15 million, for dental benefits for patients who frequent the emergency room for dental-related problems.

“We can’t separate oral health from the whole body,” said Simonne Maline, executive director of the Consumer Council System of Maine, which represents patients receiving mental health services. “We believe there are long-term savings if we can get more folks out of the emergency room and into appropriate care.”

In its 71-page report, the MaineCare Redesign Task Force estimates its money-saving initiatives will save the state $11.28 million in the 2013-14 budget year and $22.59 million the year after that.

Every dollar saved at the state level translates into additional savings for the federal government, which picks up about 63 percent of Maine’s Medicaid costs.

The task force report focuses its core recommendations on the most expensive patient populations, noting that 5 percent of Medicaid patients account for 54 percent of Medicaid costs. The most expensive patients — who often have developmental disabilities that require constant care in specialized facilities — cost the state’s Medicaid program, on average, $68,562 annually, compared to $937 for the bottom 80 percent of Medicaid patients.

The report stayed away from recommending broad-based reductions in the rates at which Medicaid reimburses hospitals and other health-care providers for treatment, a decision that drew praise.

But providers said they were concerned by other sections of the report that suggest adding to the list of hospital-acquired conditions for which Medicaid won’t cover treatment, and cutting back on Medicaid reimbursements to hospitals when patients are readmitted for the same conditions shortly after release.

“A readmission is not always due to the original care provided at the hospital,” said Arthur Blank, president and CEO of Mount Desert Island Hospital. “If a patient is discharged with pneumonia on a prescribed course of antibiotics and the patient doesn’t take the antibiotics or get the prescription filled, they’ve very likely to come back.”

Those who attended the public hearing also criticized a short-term savings recommendation in the report that would end Medicaid reimbursement to nursing homes and other residential facilities for hospital leave days — days when patients aren’t in the facility because they’re receiving hospital care. The report estimates a $160,000 savings for that change this fiscal year.

Nursing homes stand to lose crucial funding if that happens, said Richard Erb, president and CEO of the Maine Health Care Association, which represents nursing homes and other residential care facilities.

Plus, he said, the state Medicaid program is unlikely to save money if nursing home residents have nowhere to go after receiving hospital care.

“If patients become backed up in the hospitals while they wait, the estimated savings will quickly evaporate,” Erb said. “We believe this to be penny-wise and pound-foolish.”

The MaineCare Redesign Task Force plans to issue its final report to the Legislature. Any significant change to the Medicaid program requires approval — either from the state Legislature, the federal government or both — and oftentimes changes to state rules.

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