Thursday, March 13, 2008

Medicaid: The Need for Face-to-Face

Last week an appropriations bill (HB 1601) came up to fund the Medicaid program. The content of the bill mirrored individual bills I had already supported, such as the cigarette tax bill (HB 1013). However, the difference was that near the end of the bill, a provision was added that said no money would be released to the Division of Medicaid for FY 09 until they did away with the face-to-face re-certification program. I opposed this provision, but the entire bill ended up passing 74-41.

In case you didn't know, in 2005, the legislature instituted the face-to-face re-certification for Medicaid recipients to verify there eligibility for the program. Currently, everyone has to see a local Medicaid official every year to be re-certified in the program.

According to the Division of Medicaid, it turns out that 78,000 Mississippians were receiving Medicaid benefits who were not eligible for the program. Once face-to-face was implemented in 2005, this has equated to $236,727,606 of total savings. With the federal-state match that Mississippi receives, Mississippi has a gross savings of $56,814,625. After hiring the people who do re-certification, our total savings comes to a total of $42,919,450.

The House has now sent a bill over to the Senate to do away with the program that has reaped substantial economic benefit.

However, to be fair, the people proposing the program's cancellation point to the burden that is put on working parents to try and bring their children into the Medicaid office once a year. Children whose parents don't bring them in to be re-certified lose eligibility temporarily, which increases the number of uncompensated cases for hospitals. The children do, however, gain back their Medicaid eligibility when their parent finally goes through the face-to-face process. It's not that parents don't care about their children; it's the reality that parents have a lot going on and sometimes a legitimate hardship exists so they cannot renew their child's eligibility on time. The advocates of the program's cancellation also point to the hassle for disabled and elderly people to have a face-to-face visit with a Medicaid representative for re-certification.

This may be true.

However, besides the economic benefit, I think the social benefit of this program is worthwhile. The face-to-face program requires people to take ownership over their affairs. In a time where government is doing more and more things for people (which is not always a bad thing), the danger is that people begin to lose the ability to do things for themselves. We cannot create a cradle-to-grave system where people are not empowered to take responsibility for themselves. We deprive them of their liberty by perpetuating that system.

The goal of government assistance, with obvious exceptions, is to give a hand-up to the disadvantaged, in hopes that they will seize the opportunity and make a better life for themselves. If we can help parents become more involved in their child's life by making sure their child is re-certified every year, then we should.

Do we have a long way to go in health care? Absolutely. Should we seek opportunities to facilitate a better market system to provide better quality to more people? Of course. But should government do everything for those persons receiving benefits? I don't think it's wise for us to create that expectation. Face-to-face requires people take ownership of their personal and family affairs, and that is why we should keep the program.

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