Does West Virginia's Medicaid reform hurt children?
A Georgetown University Center for Children and Families analysis says West Virginia's Medicaid redesign that stresses personal responsibility for wellness has led to limiting benefits primarily for children and hasn't had a significant impact on the stated goals of improving beneficiaries' health and increasing healthy behavior. State officials reject the analysis, saying the charges are a rehash of previous unwarranted criticisms.
"We are terribly disappointed in Georgetown University," said West Virginia Medicaid spokeswoman Shannon Landrum. "The information in the report is a rehash of old discussions and misconceptions. Children are receiving all medically necessary services."
Georgetown Health Policy Institute senior researcher Joan Alker says the redesign approved by the federal government in 2006 was a unique and controversial program to restrict access to certain healthcare services if Medicaid beneficiaries did not sign and/or comply with a "personal responsibility" agreement. In the agreement that beneficiaries are to sign with their doctors, they promise to comply with a health improvement plan. Children and their parents are the primary groups affected.
Beneficiaries who complete and return the agreement receive an enhanced benefits package, while those who don't sign the agreement get a basic benefits plan that restricts prescription drugs to four per month and limits mental health services and access to physical and speech therapy. The enhanced plan doesn't contain these restrictions and also adds benefits designed to encourage wellness such as weight management and nutritional education.
"The West Virginia plan reduces Medicaid beneficiaries' access to medical services if theyor, in the case of children, their parentsdo not sign a member agreement and/or are deemed to be out of compliance with a range of behavioral requirements," Ms. Alker says. "This unprecedented and far-reaching change to West Virginia's Medicaid program was approved by the federal government in just eight business days, despite serious questions the plan raised about whether children would continue to receive needed health services."
She says her analysis shows that:
- some 85% of those affected by the changes so far are children, even though children cannot themselves sign the personal responsibility agreement and are not where the bulk of Medicaid costs lie;
- according to state enrollment data, 93% of children have had benefits restricted by being in the basic plan, with widespread confusion among families and physicians and poor implementation by the state being among the reasons why the vast majority of families are not signing the agreement; and
- because so few families have signed and implemented the agreement, the changes have resulted in limiting benefits primarily for children, with no discernible impact on the stated goals of improving beneficiaries' health and increasing healthy behavior.
Ms. Alker says that parents must sign the agreement for their children, even if the parents are not themselves enrolled in Medicaid. She says it is common for low-income children to be enrolled in Medicaid when their parents are not enrolled because West Virginia extends coverage to children at much higher income levels than their parents. "It is not totally clear why parents are not signing the agreement, but given the extremely high numbers93% statewideit seems apparent that the process is not working as currently structured," she says.
People don't understand changes
She says her review of materials sent to Medicaid beneficiaries about the changes suggests that poor implementation is a major contributing factor. Beneficiaries receive a mailing saying their benefits will change to the basic package within 90 days of their eligibility redetermination date unless they sign the member responsibility agreement, but they are not told when the 90-day clock starts. And, she says, the mailing does not clearly state that children are at risk of losing benefits and does not include information on where and how to send the completed agreement.
One of the more controversial aspects of the redesign was the issue of putting doctors in the position of monitoring compliance with the agreement, which could result in doctors' decisions denying patients their needed benefits. Ms. Alker says the state indicated that HMO claims data would be used to monitor compliance, but it appears that system has not been implemented. "Thus," she says, "at this point all children whose benefits have been restricted have lost their coverage as a result of shortcomings in the system that has led most families not to sign the agreement."
"This policy has been so poorly implemented that families and physicians don't understand it," Ms. Alker told the Charleston Gazette. "Understanding is critical if you're trying to change behavior."
Ms. Landrum countered that the state has notified Medicaid recipients of their redetermination date in a separate letter. "No children have lost coverage," she said. "We're monitoring our enrollment data to gauge the long-term success of implementation. This program is trying to prevent chronic diseases from developing in our young, healthy population. It's far too soon to call this effort a failure."
Download the Georgetown analysis at http://ccf.georgetown.edu/index/cms-filesystem-action?file=ccf%20publications/state-specific/wv%20factsheet%202008.pdf.
A Georgetown University Center for Children and Families analysis says West Virginia's Medicaid redesign that stresses personal responsibility for wellness has led to limiting benefits primarily for children and hasn't had a significant impact on the stated goals of improving beneficiaries' health and increasing healthy behavior.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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