Jun 25, 2009

The difference between similar and necessary: A Medicaid definition change in CT

As states struggle to create new workable budgets during this difficult economic time, they are forced to make difficult decisions. Connecticut is currently entertaining various options for cutting governmental costs in an effort to stimulate CT’s economy, but is putting the healthcare of Medicaid enrollees in jeopardy.

CT’s Governor, M. Jodi Rell, has proposed cutting costs by changing the definition of what can legally be provided by Medicaid. Instead of paying for ‘medically necessary’ treatments, the state will only pay for the least expensive ‘medically similar’ treatment.

Not only will this proposal put a vulnerable population at increased risk, but it probably will not save on cost as much as anticipated by the Governor (and will most likely be a lot pricier in the long-run). By cutting important corners in healthcare, we are setting ourselves up to spend much more money in the long-term. For example, this will probably increase emergency department visits due to poor management of healthcare needs and less availability of healthcare providers, put more and more families into poverty as essential medical bills will not be covered, and increase the time that healthcare providers need to spend dealing with bureaucratic red tape of defending the rationale behind their treatment plans (therefore decreasing the time that they can spend with patients, and on primary care prevention, which also saves money over time).

The Governor has stated that her budget proposal serves to "take advantage of this opportunity to reshape our government and position our state to thrive when the economy rebounds." She proposes that "If we hold the line on taxes and make the tough decisions now, we will make our state infinitely more affordable for businesses and infinitely more appealing for investment. Job creation will climb as more and more companies move to- or grow in- a business-friendly Connecticut, in jobs they find here."

However the heart of this proposal aims to draw new families into Connecticut at the expense of families that are already living here. In addition, the proposal unapologeticlly aims to "improve Connecticut" by sacrificnig the services that are absolutely essential to the well-being of one of it's most vulnerable populations.

So there it is, the difference that one word can make. To me, this issue reinforces why healthcare providers need to be engaged in the political climate of their communities. As we know, policies can tremendously impact the ways in which we practice (and more importantly, impact our patients' lives!). But we seem to sometimes forget that we have a voice in these matters, and it is our responsibility to engage.

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