Medicaid verification rules leading to higher health costs

In many states, Medicaid beneficiaries are forced to prove that they and their children are eligible for the program more than once a year. This often leads to overwhelmed families "falling off the rolls," which may lead to their not getting or filling prescriptions, receiving key diagnostic tests or managing chronic diseases adequately, a situation that costs the Medicaid program more than possibly carrying unqualified patients for a short while, suggests a new report from the Association for Community Affiliated Plans.

The ACAP represents 42 nonprofit safety-net health plans which serve six million beneficiaries in 23 states, so it well understands the problems of the Medicaid population. However, Medicaid administrators themselves may be out of touch, the data suggests.

Not only do such "cumbersome" policies threaten patients' health, they make it more difficult to manage the Medicaid programs appropriately. With patients churning in and out of the program every few months, they note, federal goals for measuring the quality of patient care are very hard to administer, if not impossible.

The ACAP would like to see Congress pass a "Medicaid Continuous Quality Act" that would set up 12-month continuous eligibility. This change might cost Medicaid programs more, it would save money in the long run. It calculates that adults enrolled in Medicaid for one month in 2006 had estimated average expenses of $625, while patients enrolled six months had expenditures of $469, and individuals enrolled for a year had monthly costs of $333. They attributed the lowered costs to the fact that continuously-enrolled patients get more preventive and primary care, reducing the need for more costly care.

To learn more about this issue:
- read this Health Leaders Media piece
- read the ACAP study (.pdf)