Many people watching Medicaid reform

By NANCY HICKS / The Associated Press

A group of more than 50 people watched warily Wednesday morning as a ten-member council began talking about reforming the Medicaid program.

"We know the system is broke, but we do not want to see a cut-and-slash type of mentality," said Kathy Hoell, executive director of the statewide Independent Living Council.

The Medicaid Reform Advisory Council's members are appointed by Gov. Dave Heineman and the Legislature's Health and Human Services Committee. Their job is to help write a Medicaid reform report for the Legislature.

There are no consumers on the council, no one whose life will be directly impacted by the decisions that come out of the reform, said Alan Green, with the Mental Health Association of Nebraska, a consumer-run organization.

Medicaid is important to the state. That's why there is so much interest in this council, said Roger Keetle, lobbyist for the Nebraska Hospital Association.

Any changes in Medicaid will affect the various groups differently, he said.

Last year, 256,000 Nebraskans participated in Medicaid, funded by federal and state taxes.

Medicaid pays the bills for low-income seniors in nursing homes.

It pays for prescriptions and some medical costs for very low-income seniors.

It helps pay expenses for adults with mental retardation living in a group homes.

It provides medical care to low-income adults with serious mental illness.

It provides health care for low income pregnant women and for children in moderate and low-income families.

Medicaid touches many lives and livelihoods.

Doctors, hospitals, dentists, group home workers and nursing homes are among the professional groups that earn at least a part of their livelihood from Medicaid.

It is the single largest health and long-term care program in the country, with a $329 billion national price tag, said Dick Nelson, a Health and Human Services administrator who will help write the reform report.

That intense interest from people who get their health care through Medicaid and those who earn money providing those services doomed the last reform process. Turf protection stymied a 2002 Medicaid study, acknowledged Sen. Jim Jensen, chairman of the Legislature's Health and Human Services Committee.

Reform can be a good. Years ago, about 4,000 Nebraskans were placed in the Beatrice State Developmental Center.

"Notice I said placed, not were living there," said Deborah Weston, executive director of ARC of Nebraska, representing people with developmental disabilities and their families.

Then reform opened up new options for people with developmental disabilities.

Now the BSDC serves less than 400 people. And 4,000 people live at home or in apartments and group homes, with some help, she said.

It costs less to keep people in their home communities than in an institution, she said.

The discussion Wednesday centered on numbers: Medicaid's  price tag, and the pressure on state government, which pays 40 percent of those costs.

But Weston hopes to show the council the people behind the numbers.

"We have to look at how reform will affect people, vulnerable people. We don't want to put them in harm's way," she said.

So all the talk about reform, making Medicaid more efficient, about curbing costs, "is scary," she said.

But the Nebraska rancher in her says, "We will figure out a way."

The Medicaid Reform Advisory Council was created to advise the two men who will write the reform report. They are Nelson of HHS, representing Gov. Dave Heineman, and Jeff Santema, attorney for the Legislature's Health and Human Services Committee, representing the Legislature.

The two expect to have a rough draft of their recommendations by mid-October and a final report in early December, with three public hearings across the state in between.

Reach Nancy Hicks at 473-7250 or nhicks@journalstar.com.