The Medicare & Medicaid Center

Many states do a poor job of regulating Medicaid fraud because it is a not a simple matter economically.  After all, for ever dollar Medicaid brings into a state, there is a federal matching dollar hat the state receives.   Some states even overpay Medicaid providers, collect matching federal funds, and collect kickbacks of overpayments, thus becoming part of the fraud problem.

The question then becomes, what is the sense behind turning the oversight of Medicaid over to the same government that is participating in the fraud?  Their actions have created long waiting lists, rationing of care and poor delivery of not enough care, again controlled by the government.

There is another side to the issue, however.  What happens when you need to make the numbers work?  It’s important to look at the major problem.  There are many honest and caring physicians who try to help as many individuals on Medicaid as possible.  The problem is that even the busiest physicians that take Medicare can’t take more than about 28% of their caseload in Medicaid patients, they can’t afford to stay in business because the amount they are reimbursed is lower than the services provided.  Therefore, if there are too many Medicaid patients seeing a particular doctor, he loses money until he can’t afford to stay in business any more.

We haven’t even talked about the number of children covered by Medicaid for various reasons.  There are over 25 million kids that have various forms of Medicaid coverage.  There are Targeted Case Workers and Case Management through Medicaid Rehabilitative Services who do all they can to deal with children’s’ physical and mental disabilities – getting help and services for them while keeping expenses to Medicaid and to physicians under control.  A federal-state partnership that exists now to cover these expenses could be eliminated if some politicians get their way. 

Looking at both sides, the hope is that the politicians will be able to work with the expenses while remembering that these issues are not only about finances, but at the heart of the issues are children and adults with vulnerabilities and disabilities that depend on the Medicaid system to help keep them well.