Managing the health-care dollar Md. on cutting edge: Making Medicaid procedures for elderly poor sensible and less costly.

November 09, 1996

THERE IS NO way Maryland officials can erase the state's chronic budget gap without reforming health-care services for poor people. The Medicaid program is growing at twice the rate of revenue growth for the state. Squeezing excess cost from the system is a budgetary imperative.

But it is also a health-care imperative. Some 210,000 poor mothers and their children need better ongoing preventive care. Another 100,000 Medicaid recipients are elderly, disabled or chronically ill and find themselves in programs that are uncoordinated and often at odds with the needs of the patient.

State officials have embarked on a cutting-edge initiative to overhaul Maryland's approach to Medicaid health-care treatment. And no wonder. This is a $2.2 billion program with costs rising rapidly. Gov. Parris Glendening must find a way to reduce Medicaid expenses if he hopes to free up money for education, public safety and economic development initiatives.

Managed care is one route. Early next year, welfare recipients will have to shift to managed-care programs, such as HMOs, that offer not only considerable savings but the prospect of more regular medical treatment aimed at preventing serious illnesses. Doctors, hospitals and managed-care groups are now lobbying state legislators and Dr. Martin P. Wasserman, the state health secretary, over the details. But Dr. Wasserman will have the final say.

A far bigger problem stems from the hodge-podge of Medicaid procedures for the elderly poor and disabled. There is no well-coordinated continuum of service, no policy that assures an individual proper care in the most appropriate setting. Services are often duplicated or fragmented. Sometimes the needed assistance isn't even available. It is a failed system crying out for a better approach.

Not surprisingly, patching together managed-care rules for poor mothers and children is proving difficult. But a few months' delay in setting up this new program is understandable if it means a smoother and more sensible delivery of services.

The tougher decisions by Dr. Wasserman will come late this year on reforming the rest of Medicaid, which deals with the sickest and most vulnerable patients. It could mean a shakeup in how nursing homes, hospitals and other facilities for the elderly and disabled operate. The goal should be a rational, coordinated process that gives older Medicaid recipients the care they need in the most appropriate and affordable setting. We can do better than the present Medicaid setup. We must do better.

Pub Date: 11/09/96

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