Maryland may have to delay implementation of its plan to switch Medicaid recipients into managed care plans to give more time to work out regulations, Sen. Larry Young, chairman of the state Senate Health Subcommittee, said yesterday.
State health officials, however, said they are still ready to move ahead on schedule, beginning the process Jan. 1 and placing 220,000 Medicaid recipients in managed care plans by the end of June.
About 110,000 additional Medicaid recipients are already in health maintenance organizations, but would have the opportunity to switch to other managed-care plans during the enrollment period for the others.
The state budget for the current fiscal year, which ends June 30, and next fiscal year assumes that the plan begins on schedule. The switch to HMOs is expected to save $8 million a month when fully operational.
HMOs have established a track record of keeping health costs below those of fee-for-service medicine. HMO and other managed-care patients are assigned a primary care physician, who is supposed to provide preventive care, such as immunizations, and who controls access to specialists and other health services.
Thus, the state looked to managed care as a way of controlling rapidly mounting costs in Medicaid, the $2.8 billion-a-year program that insures health for low-income people.
As the state has rushed to meet deadlines for guidelines, some health providers and advocacy groups have argued that there has not been enough time for insurers and providers to review regulations -- not yet final -- and reimbursement rates.
"There's too much left to be done," said Bobbi Seabolt, lobbyist for the Maryland Chapter of the American Academy of Pediatrics, who testified yesterday at a hearing, the third in a series on regulations to carry out the switch to HMOs. "Some managed care organizations are still forming, and they have to send the rates to the providers, who need time to analyze them."
"We'd like more time to do education," said Leigh Cobb, representing Advocates for Children and Youth. "The population doesn't have sufficient knowledge about this. We'd like to try to develop materials that can be distributed statewide."
On the other hand, Martha Roach, executive director of the Maryland Association of Health Maintenance Organizations, said most HMOs in her association are anxious to move ahead.
While the association does not have a position on the advisability of a delay, she said, the majority of her members feel that "overall, the health department has been responsive to a lot of our concerns, and is continuing to work with our remaining concerns."
Young, a Baltimore Democrat, said that although budget concerns are legitimate, "I'd rather be slow and right."
The senator said he needs to think more about how a delay would work, but that he could have recommendations ready for next week's meeting of the joint committee of the Legislature that reviews regulations.
Barbara Shipnuck, deputy state health secretary, said, "We believe we're on target for Jan. 1. The number of issues has been reduced substantially, although some organizations that didn't get 100 percent of what they wanted will continue to try to get 100 percent. We believe we have a balanced set of regulations taking account of all the interests."
She said that the department would study, at Young's request, the implications of beginning the program later.
Pub Date: 10/09/96