Aloha State’s ex­pe­ri­ence might of­fer lessons for Med­i­caid, too

Modern Healthcare - - COMMENT -

Re­gard­ing the ar­ti­cle “In Medi­care, states are far from equal” (April 17, p. 12), while Hawaii has had lower costs per ben­e­fi­ciary in Medi­care, it also has his­tor­i­cally had more gen­er­ous Med­i­caid el­i­gi­bil­ity, in­clud­ing for those dis­abled adults re­ceiv­ing gen­eral as­sis­tance mak­ing less than 200% of the fed­eral poverty level prior to the ACA. We have also had broader par­tic­i­pa­tion his­tor­i­cally by pri­vate-sec­tor physi­cians com­pared to most states, although in­creased man­aged-care re­stric­tions have re­duced physi­cian par­tic­i­pa­tion since 2009.

Per­haps the truth is that broader ac­cess to out­pa­tient care cor­re­lates with lower ER and hos­pi­tal uti­liza­tion, lead­ing to lower to­tal Med­i­caid spend­ing. Maybe ef­forts by many states to con­trol Med­i­caid costs by re­strict­ing uti­liza­tion of care via re­strict­ing el­i­gi­bil­ity and ben­e­fits are ac­tu­ally hav­ing the ef­fect of driv­ing to­tal spend­ing per ben­e­fi­ciary up, not down. Re­strict­ing care does not re­strict disease, which of­ten comes back in more ex­pen­sive forms.

Dr. Stephen Kem­ble As­sis­tant clin­i­cal pro­fes­sor of medicine John A. Burns School of Medicine Uni­ver­sity of Hawaii at Honolulu

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