Youngstown Daily Legal News

Bipartisan bill would establish Medicaid reforms

TIFFANY L. PARKS
Special to the Legal News
Published: July 18, 2013

Sen. Dave Burke, R-Marysville, says that regardless of federal law, the current Medicaid system is not sustainable.

“We cannot continue to spend more and more, and have Medicaid eat up more of our budget,” he said. “We need to find ways to provide more services to more people in a more efficient and cost-effective manner, thereby bending the cost curve and moving people up and out of Medicaid and onto a path of self-sufficiency.”

Senate Bill 145, jointly sponsored by Burke and Sen. Capri Cafaro, D-Warren, was drafted with that in mind.

The proposed legislation, which both lawmakers described as a starting point, would reform the state’s Medicaid system through establishing firm spending targets and performance measures and standards that focus on medical outcomes.

The measure is also designed to increase consumer involvement in the delivery of Medicaid services, remove costly legislative mandates that prohibit innovation and flexibility and streamline legislative involvement in caseload.

“Over the last several weeks, the Senate has been working diligently with the Ohio House and the administration on ways to restructure Ohio’s Medicaid program with the goal of improving the Medicaid program for the lives we serve and the taxpayers who pay the bills,” Burke said, noting that the conversations have been productive and bipartisan.

“This process of reform is not something that is going to happen overnight, but I am confident in the path that we are on and the legislation that is in front of us.”

If enacted, SB 145 would limit the growth in Medicaid’s per member per month cost, reduce the number of individuals needing Medicaid and adjust standards to provide Medicaid recipients with information about the actual costs of services.

In addition to its other aims, the bill’s provisions call for creating the Joint Medicaid Oversight Committee, investing in research and evaluation for Medicaid and the state’s entire health care system and eliminating statutory regulations that impede the cost-effective care.

Cafaro said the focus of reforming Medicaid would be on quality, yet cost-effective, care.

“By making Medicaid more cost effective, we will have the tools necessary to provide the best coverage to more citizens,” she said, adding that the proposed legislation would require the director of the Ohio Department of Job and Family Services to implement reforms to workforce development activities.

“... the workforce development part of the bill is intended to help bridge any gap between health care access and work. The last thing we would want is to create perverse incentives that make it difficult for people to increase their overall economic stability.”

Cafaro also highlighted the purpose of the proposed oversight committee.

“This committee would work to keep up with the moving parts of this complicated program. It would consult with industry experts, professional staff and evaluate and make recommendations on rules and the Medicaid reforms,” she said.

Cafaro said the committee’s suggestions would be taken into consideration when the legislature or the Joint Committee on Agency Rule Review votes on applicable matters.

“We are also already in the process of drafting a substitute bill which will further shape the goals and policies of the Medicaid program,” she said, noting that the policies will include cost control mechanisms and goals, incentives to reward quality over quantity of care, requirements and flexibility for payment innovation and linkages to workforce development.

“I feel I must take a moment to go back to the basics and emphasize what we are here to do. As a member of the General Assembly, I take no duty more seriously than taking care of our citizens who quite frankly need help,” she said.

“It is imperative that we do everything in our power to bridge coverage gaps, allowing people to take care of themselves and promoting health and financial security.”

In fleshing out the bipartisan initiative, Cafaro said she will not “lose sight of the people that need coverage and that will be left in the cold if we fail to act.”

“This bill would contribute to the health of all low-income Ohioans and do it as cost effectively as possible,” she said.

“It creates a system that will allow for change and improvements in an ever-evolving industry. While this is the first step, I look forward to bringing an even better bill before this committee that truly shows, in detail, all of the policy implementations to get Ohio to where we want to be — a state where all Ohioans have dependable, quality health care.”

Burke said he believes it’s possible to bring true reform to Medicaid.

“We have to remember when it comes to Medicaid, the taxpayer is the provider. Tax dollars we spend on Medicaid are dollars we are taking away from education, economic development and other items important to Ohio,” he said.

“I believe it’s possible to achieve our objectives and bring true reform to Medicaid that is cost-effective and outcome driven. This bill will enable us to determine what that looks like.”

SB 145 is before the Senate Medicaid subcommittee.

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