October 21, 2005 Charleston Gazette
Manchin joining panel

Congressional Democrats oppose Bush Medicaid Commission

By Scott Finn
Staff writer

Gov. Joe Manchin is being named to a Bush administration commission to redesign Medicaid, according to a high-ranking Manchin administration source.

Manchin would fill one of two slots for active governors on the 15-person Medicaid Commission. West Virginia’s Medicaid commissioner, Nancy Atkins, already serves on the panel.

Last month, the state Medicaid Commission recommended $11 billion in cuts to the program. Next, the commission is supposed to find long-term savings while improving health care to recipients.

Several congressional Democrats opposed the creation of the Medicaid Commission, including House Minority Leader Nancy Pelosi, D-Calif., and Senate Minority Leader Harry Reid, D-Nev. They refused to recommend non-voting members to U.S. Secretary of Health and Human Resources Mike Leavitt.

“Any Democrat who was to accept an invitation for Leavitt to serve on the commission would do so in contravention to the explicit position of the party’s leadership in Congress,” says a June article in “The Hill,” an independent newspaper covering Congress.

Manchin spokeswoman Lara Ramsburg would not confirm Manchin’s appointment.

“I am waiting for information from the Commission,” Ramsburg wrote in an e-mail. “It is my understanding they should be announcing something on this topic from their end soon.”

Manchin has proposed a major restructuring of West Virginia’s Medicaid program, which provides health care to low-income children, pregnant women, the disabled and the elderly.

The federal government gives West Virginia almost $3 for every $1 it spends on the health program, which served more than 350,000 state residents last year.

Some of Manchin’s proposed changes include:

Limiting benefits to certain groups of recipients to what state officials believe they actually need.
Changing who is eligible for the program.
Charging co-pays to beneficiaries.
Giving “health investment accounts” to participants to spend on their health care.
Rewarding and punishing participants based on how they use the system.
In May, the state published a “concept paper” with broad goals for the program, but few specifics.

Since then, a group of state officials and others have worked on the proposal, but no further drafts have been made public.

Some health advocates want to see the revised concept paper before state officials take it to the federal Centers for Medicare and Medicaid Services, which must approve any changes.

Two states, Arizona and Florida, were able to receive federal approval for Medicaid changes before the public saw their final waiver proposals, according to media reports.

Martha Yeager Walker, state Secretary for Health and Human Resources, said the public can see the new concept paper after it is given to federal officials, but not before then.

She promised the public would be able to comment before any final proposals are made to the federal government. The agency has a self-imposed deadline of July 1 to start the new program.

“Whatever we send in will be loose enough so it can be changed after it is submitted,” she said.

So far, the plan has been long on concepts and short on specifics, said Scott Miller, a Lewisburg advocate for people with disabilities.

He is frustrated with the lack of details coming out of the state Department of Health and Human Resources about the plan.

One subcommittee has suggested cutting some disabled people from Medicaid who are part of the federal Supplemental Security Income program.

As it is now, West Virginia automatically gives someone a Medicaid card if they qualify as disabled through SSI. But the proposal calls for West Virginia to set up a stricter definition of disability for the 78,000 SSI recipients in the Medicaid program.

“This is all about cutting people from the program,” Miller said. “This will decrease the supports people get. The people who will be hurt the most are the elderly and people with disabilities.”

Walker said she didn’t know the details of the proposed SSI cuts. She said these are all just recommendations and the state hadn’t submitted a formal plan yet.

State officials are proposing these changes without knowing exactly how many people would be affected or how much, if anything, it will save, said Mike Robbins, association vice president for financial policy.

The state’s new Unisys computer system hasn’t been able to provide accurate data regarding expenditures, he said.

“We know we need to look at the future of this program, because state revenues are not keeping up with demand,” Robbins said. “But before we redesign, we need information about what is actually happening today and how beneficiaries will be impacted.”

Walker promised that any changes would not hurt current beneficiaries.

“We’re responsible for their health care. It’s not to our benefit to shortchange them of necessary services, because in the long run they’ll be hospitalized,” she said.

“The goal is not necessarily to save money. The goal is to contain the rapid growth of Medicaid, and provide quality services to Medicaid members,” she said