The General Assembly put its imprint on a sweeping health care bill this week, finalizing a detailed plan that will shift tens of thousands of Maryland's poor into HMOs -- and save the state hundreds of millions of dollars.
The legislation lays out how Medicaid patients will get their care. And its specific words will shape which clinics, health plans and physicians get a shot at millions of dollars -- and one of the last untapped markets for health maintenance organizations.
One of the key provisions would ensure the survival of school-based health clinics that have been major sources of care for children in the Medicaid program. Another provision would toughen quality requirements for HMOs that want to serve Medicaid patients.
Almost every state is making a similar move to control Medicaid costs and make sure the poor have access to physicians and coordinated care. In Maryland, although the $2.3 billion Medicaid budget consumes a fifth of the state budget and is growing at 10 percent a year, many people on Medicaid don't have physicians and end up going to the emergency room for a sore throat.
Instead of being able to visit any doctor or hospital, Medicaid recipients will be required to have all their medical care coordinated by HMO doctors and staff. The legislation, however, would initially guarantee that doctors who have been taking care of Medicaid patients could continue for at least one HMO.
The change in Medicaid programs is a microcosm of the revolution shaking the country's health care system.
While many private employers have moved their workers into managed care, or HMOs, the government is just beginning to do the same for the poor and disabled in Medicaid, and the elderly in Medicare.
The move into managed care raises thorny issues for Medicaid recipients, whose poverty and social problems may make it difficult for them to navigate the HMO system. And, like other Americans, they may lose longtime doctors and struggle to adjust to a system with more restrictions on specialists and tests.
"I am worried about the quality," said Melody Fulton, 39, a Baltimore resident and Medicaid recipient who served on a steering committee that developed the proposal.
"You can't go where you need to be. Instead, you have to go where they tell you to."
Protecting patients
