For decades, no other challenge has been greater for a succession of governors and their administrations than the Medicaid program of health care for the poor, elderly and disabled.
Despite the fact that the federal government picks up most of the states costs of Medicaid, soaring health care costs have meant that the states share soared as well. In a comparatively poor state like Kentucky, that has meant a funding crisis for Medicaid almost every two years.
Brereton Jones tackled the problem and failed. Paul Patton tackled the problem and failed. Now, it is Gov. Ernie Fletchers turn, and we all must hope that he doesnt fail as well.
Fletcher and Health and Family Services Secretary Mark Birdwhistell last week unveiled the latest effort to rein in Medicaid costs, which have been threatening to bankrupt the Treasury in recent years.
They announced federal approval of the first program of its kind in the nation. Rather than continuing offering the same health services to all of the roughly 700,000 Kentuckians who receive Medicaid, the new program offers a variety of options and benefits to suit their particular health problems.
According to an individual patients plan and income, some will be required to pay a co-pay for certain services and procedures. Unnecessary trips to emergency rooms will be discouraged as well as excessive monthly prescription drugs. And the program will focus attention on preventive care and assisting patients in taking better care of themselves.
For some Medicaid patients, the new program will cost more money. For others, however, there should be little additional expense.
Much of what was announced last week makes sense. Clearly, a teen-ager with mental or physical handicaps requires an entirely different type of health care than an elderly patient with diabetes or cancer. By targeting care toward the actual condition of patients and groups of similar patients, there must be an overall cut in costs or, at least, a leveling off of cost increases.
Fletcher said, Its landmark reform, and its reform that will be modeled, I believe, across the United States.
And Dennis Smith, director of the federal Center for Medicaid and State Operations, said, You are now focusing benefits on the people who need them and to tailor the benefits around their unique situations. Medicaid is made up of different populations. But in the past it was just all or nothing.
In every respect, it sounds entirely reasonable.
But weve heard similar rosy predictions and assessments time after time, only to have yet another funding crisis rise up and threaten the program.
We can only wait and hope that this time is the right time and way to fix Medicaid in Kentucky.