In a move aimed at overhauling the way poor people receive health care, Maryland began yesterday to require patients on taxpayer-funded Medicaid to enroll with a private doctor, rather than relying on hospital emergency rooms when they are sick.
Health Secretary Nelson J. Sabatini said the requirement will save the state about $24 million over the next year -- but the main motivation is to ensure that Medicaid patients receive early treatment of their illnesses and preventive care, such as immunizations and mammograms.
Starting yesterday, most new applicants to Medicaid will be given 30 days to select a primary care physician or risk getting assigned one by the Department of Health and Mental Hygiene. Existing clients will be required to do the same when they re-apply for Medicaid, as they must do every six months under old rules.
Declaring a "new era" for Medicaid, Mr. Sabatini said yesterday that Medicaid recipients have been plagued with unnecessarily high rates of infant death, cancer and other diseases because -- all too often -- they have not received regular medical care from physicians responsible for their overall health.
Instead, many have relied on hospital emergency rooms, or gone fromspecialist to specialist -- often getting conflicting treatments for the same problem.
"This should put an end to doctor-shopping and inappropriate use of emergency rooms for non-emergency care," Mr. Sabatini said at a press briefing yesterday. The cost savings should result from a reduction in more expensive hospital visits, but will not make a major dent in Maryland's overall Medicaid tab -- expected to reach $1.5 billion this year.
Requirements of the new program, called Maryland Access to Care, will apply to all medical assistance patients except those in nursing homes and those who live on their own but also qualify for Medicare. Mr. Sabatini estimated that within a year, the program will have enrolled some 320,000 people -- roughly two-thirds of the Medicaid population.
Voluntary enrollment began last April, and so far 35,000 patients in Baltimore alone have signed up with private doctors.
The doctors, who themselves register as MAC providers, will act as the patients' "gatekeepers" -- delivering their basic medical care while referring them to specialists for problems outside the gatekeeper's expertise.
As patients enroll in MAC, they will receive a "gold card" that fTC must be presented to any medical office they visit. The card will contain their regular doctor's name and telephone number. Physicians who have not received a direct referral from the patient's gatekeeper will be required to call that doctor to obtain permission to treat the patient.
Just two weeks ago, Gov. William Donald Schaefer announced plans tocut welfare benefits to families who don't take their children to the doctor or to school. While the new Medicaid rules don't contemplate cuts in services, Mr. Sabatini said they represent another effort to impose greater responsibility on recipients of public benefits.
To encourage more doctors to treat Medicaid patients, the health department has increased its reimbursements. Office visits that once paid $7 to $10 will now pay $20, he said -- still much less than the rates paid by private insurers, but enough, Mr. Sabatini said, to attract more doctors.
Patients asking for lists of MAC "sites" in their area will be able to choose from private doctors, health maintenance organizations and hospital outpatient clinics.
"I think this is going to have a fairly good impact on people," said Pat Cassatt, executive director of the People's Community Health Center on Greenmount Avenue. "It will set up that old family doctor type of relationship between patients and doctors. That's something that's been missing, especially in the Medicaid