Editorial: State aims to build a better Medicaid

  • Updated: August 2, 2012 - 6:14 AM

More choices, care coordination are Reform 2020 goals.

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It's been rare recently for a partisan budget brawl to end harmoniously at the State Capitol. It's even rarer for the deal that's struck to last longer than a year or two, and to lead to better, more cost-effective government service.

A proposal that the Department of Human Services will send to the federal government this month stands a good chance of falling into that seldom-seen category. Called Reform 2020, it's a request for the feds to grant Minnesota the requisite authority to pursue an ambitious redesign of Medicaid, the $8 billion-a-year, state-federal health care program also called Medical Assistance.

The effort deserves Minnesotans' notice and good wishes as it heads to the federal Centers for Medicare and Medicaid Services for approval.

Reform 2020 is a promised product of the budget deal struck by the DFL Dayton administration and the Republican-controlled Legislature to end the July 2011 state government shutdown. It ended more than six months of squabbling over how and how much to cut state Medicaid spending over the next two years.

The result is a map for the remainder of this decade for making Medicaid dollars stretch farther and serve elderly, needy and disabled people better.

It aims to eliminate the frustrating and costly runaround to multiple service providers that many of Minnesotans' neediest and sickest people today must endure to receive help. Today it's not uncommon for a low-income person suffering from both chronic mental and physical illness to deal with five or six case managers of separate public programs. Reform 2020 would allow a single care coordinator to put those services together in individualized, cost-effective ways.

The proposal also sets out to implement long-discussed ideas for giving elderly and disabled Minnesotans more independence and more choices about how public-assistance dollars are spent. Some examples of the changes the Department of Human Services envisions:

• Today's Medicaid program pays for personal-care attendants for disabled people, but won't cover the cost of bathroom modifications or home equipment that would reduce or eliminate the need for personal-care help. Reform 2020 would allow Medicaid funds to be used for such purchases.

• Today's Medicaid services are either "on" or "off." People with episodic disabling conditions, such as multiple sclerosis, wind up either getting more costly care than they need or end up struggling -- sometimes in expensive emergency rooms -- when their conditions abruptly worsen. Reform 2020 would establish a state registry of care providers specially trained to handle intermittent disorders "on call."

• Today's Medicaid restrictions limit who can provide services to disabled people. Reform 2020 proposes to allow the disabled more freedom to choose who helps them, and to make it easier for chosen assistants to receive the training and support to do it well.

How much money can be saved with changes like these isn't clear. State officials say they hope to have estimates in time for the 2013 Legislature's budgetmaking. But the savings are expected to be substantial. What's more, disabled people and their advocates have testified that giving them more control would make them better able to cope with any future cuts in Medicaid spending.

The Legislature's partisans will still have plenty to disagree about in coming years as they consider the state's rightful role in meeting the health care needs of the poor and disabled.

But if the Reform 2020 federal waiver request is granted, Republicans and DFLers should quarrel less often about how to wring waste and overspending out of Medicaid. They can instead oversee the rollout of a promising plan to do just that.

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  • REFORM 2020 VISION


    The Department of Human Services cites these ideas:


    •Achieve better health outcomes.

    •Simplify program administration and access.

    •Support the desire for a meaningful, self-directed life at all stages of life.

    •Design government help to maximize flexibility and responsiveness.

    •Ensure program's long-term sustainability.

    Source: "Reform 2020: Pathways to Independence," Department of Human Services, July 2012.

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