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Reducing Medicaid costs in Colorado

The topic of health reform continues to be important at state legislatures across the country and Colorado is no exception.

Much of the public’s attention centers on the U.S. Supreme Court case to be heard at the end of March, deciding the constitutionality of the federal health reform bill. The court will spend an unprecedented amount of time hearing the case and its decision is expected in June.

In the meantime, there are a number of efforts, including legislation, going on in Colorado aimed at reducing the costs of the Colorado health care system, particularly in the Medicaid program.

Medicaid is, essentially, the state’s payment system for health care services to those who qualify due to low incomes. The program is a shared state/federal program and, in Colorado, federal funds match the amount of state funds equally.

There’s been a massive expansion in Colorado of those eligible for Medicaid, for several reasons. The federal health reform law requires an expansion covering families with an income at or below 133 percent of federal poverty level (FPL). This translates to a 2012 annual income of roughly $31,000 for a family of four.

Another factor driving the increase in Medicaid eligibility is the large number of unemployed or underemployed workers as a result of the recession. Because of their loss of income, they’re now eligible for Medicaid.

Growth is also expected among those who were eligible for Medicaid, but weren’t enrolled for one reason or another, and are expected to enroll under the health insurance exchanges.

Finally, another big driver for Medicaid program growth is the increasing number of elderly people entering into long term care without adequate savings to pay for that care.

Focusing on reducing costs may sound cold and distant for something as personal as an individual’s health care. Yet, the costs associated with the massive expansion of Medicaid requires that a legislator keep an eye on the bottom line as the tax dollars spent on health care won’t be spent in other areas such as education, roads and public safety.

I’m sponsoring two bills this session aimed at reducing costs in the Medicaid program. One of the bills seeks to improve the prosecution of fraud in Colorado. There are two avenues for fraud in the Medicaid system. One is by the providers, meaning doctors, hospitals and suppliers of equipment and services. The other is by the client or recipient of the Medicaid services.

Who’s responsible for prosecuting Medicaid fraud in Colorado depends on who’s committing the fraud. Legislators lack solid, comprehensive information on what Medicaid fraud is occurring and what improvements are needed. My bill provides for better collection of information and sharing it with the legislature. I’ve been working with the Colorado Cross-Disability Coalition on the bill’s language and direction. Diverting precious resources from those who are truly eligible to those who are scamming the system is unacceptable to the coalition as well.

My second bill provides greater outreach to those entering long-term care to consider choosing assisted living facilities, when appropriate, rather than the more intensive and expensive nursing homes. It also provides legislative support for better reimbursement to alternative care facilities to accept the Medicaid clients.

Both of these bills have received strong bipartisan support in the Senate and appear headed to the House shortly.

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