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Options for Slowing Rising Medicaid Bill

Introduction

The American healthcare system has several initiatives intended to address the medical needs of more citizens. A good example is Medicaid, a state and federal program designed to cater for the healthcare expenses of low-income persons. Some of the key beneficiaries include young children, some persons with disabilities, and pregnant women. In the recent past, many states have been recording increasing Medicaid bills to meet the medical needs of qualified candidates. This trend means that the program is becoming unsustainable and incapable of empowering most of the targeted beneficiaries. The proposed options for reducing the rising Medicaid bill include reconsidering eligibility and administrative costs, cutting reimbursements, pharmaceutical, and benefits costs, addressing fraud, promoting competition and copayments, and reducing long-term care.

Cutting Eligibility Levels

The governor and key stakeholders can liaise with members of the legislature to cut eligibility levels. The advantages associated with this option include the ability to reduce the percentage of families and people benefiting from the program while keeping reimbursements as low possible as possible. The first major challenge associated with this option is that the state will have a reduced number of citizens with proper health coverage (Jackson et al., 2021). The second one is the possibility of a healthcare crisis whereby the state will have to incur additional costs in the provision of personalized medical services. The third problem revolves around the issue of insurance, whereby more people will have to purchase available health policies.

Imposing Administrative Burdens

Administrative costs are necessary to streamline official functions and health insurance processes. Crowley et al. (2020) indicate that Medicaid remains the leading healthcare payer since it is associated with low administrative costs. The move to impose additional burdens could discourage more people from becoming qualified beneficiaries. The major benefits of this strategy include the ability to reduce Medicaid bills and eventually improve reimbursements to the current number of citizens. However, this effort has the potential to trigger various disadvantages and disorient the program. For example, the state will be unable to receive the relevant federal funding (Hu et al., 2018). The initiative will ensure that more people are unable to enroll in the Medicaid program, thereby being compelled to incur additional medical expenses.

Cutting Benefits

American states have the option to cut the benefits available to qualified or listed beneficiaries. The major advantages associated with this plan include the ability to keep expenses or bills as low as possible and ensuring that the specific government focuses on other areas of the economy. Unfortunately, this option is associated with a number of drawbacks that all key stakeholders should examine carefully. Hu et al. (2018) reveal that the decision has the potential to result in increasing levels of federal funding. The members of the society will be unable to receive high-quality services since some of the benefits will be removed. Without proper state mechanisms, the local economy might be affected negatively and make it impossible for more people to receive high-quality medical services.

Cutting Reimbursements

The move to cut reimbursements stands out as a viable option for reducing the current Medicaid bill. The first benefit associated with this strategy is the ability to make the current percentage of payments at a manageable level. The second one is that the approach will allow private practitioners and specialized physicians to make arrangements with other medical insurance providers in the country (Sugar et al., 2021). These trends will improve the insurance marketplace and make it possible for citizens to identify the most appropriate policies. However, some challenges are possible if the state focuses on this initiative. In their study, Hu et al. (2018) observed that the idea of reducing reimbursements failed to address most of the budgetary issues affecting state governments. The model could make it impossible for more hospitals relying on such funds to continue providing timely and personalized medical services. The end result is that the overall well-being of more patients in the country will record negative health experiences.

Cutting Pharmaceutical Costs

Medicaid is designed in such a way that it caters to patients pharmaceutical costs. However, some stakeholders believe that the approach has led to an increasing amount of payments that need to be made. This tactic can guide the state to reduce the increasing bill and make it more sustainable. The option will allow Medicaid to consider the eligibility of different pharmaceutical companies and ensure that expensive drugs or inflated prices are identified in a timely manner. However, this initiative would be problematic since it does not necessarily protect the identified beneficiaries from expensive drugs (Sugar et al., 2021). The decision to cut such costs could compel more people to incur out-of-pocket expenses (Hu et al., 2018). Such developments will have negative impacts on the overall outlook and sustainability of the states healthcare sector.

Reducing Fraud and Abuse

The implementation of Medicaid is a process associated with numerous problems in different states across the country. For instance, Sugar et al. (2021) identify abuse and fraud as key challenges that result in the wastage and misuse of resources. The introduction of proper mechanisms to prevent these issues will make the program more sustainable and reduce the current bill. The model will guide state officers to detect culprits and questionable activities. The proposed strategy will result in punitive measures and possible prosecution of the identified culprits. The reduction of fraud will ensure that more funds are reimbursed to hospitals and pharmaceuticals in the state (Crowley et al., 2020). However, this initiative could backfire since most of the criminals committing such offenses collude with different officers and stakeholders. The introduction of fraud reduction measures could result in additional expenses, thereby triggering an increase in the current Medicaid bill.

Imposing Copayments

The imposition of copayments will allow Medicaid to cater to specific costs while empowering clients with personal insurance plans. This strategy has the potential to reduce the current Medicaid bill recorded in the state. More people will be able to access a wide range of medical services from standard physicians or doctors (Crowley et al., 2020). While this method sounds practical, it can make it impossible for more citizens enrolled under Medicaid to acquire or afford various medical services. The approach could disorient the manner in which people with low income and their children access most of the available medical services.

Encouraging Managed Care

The consideration of managed care in the state is an evidence-based approach capable of keeping Medicaid costs as low as possible. This initiative is expected to preset several benefits to both the government and the targeted citizens. For instance, the initiative will allow more people to receive accredited and quality care. The available prescriptions and drugs will become cheaper and more affordable (Jackson et al., 2021). The established network of providers will reduce duplication of tests and medical procedures, thereby reducing the overall level of payments. However, the initiative might not meet the demands of underserved populations. The number of persons who would qualify for coverage will remain low, thereby affecting the sustainability of the sector negatively.

Cutting Long-Term Care Costs

Another option that is capable of keeping Medicaid costs manageable is the idea of reducing long-term medical costs. This effort will allow the program to reduce the funds reimbursed to long-term care facilities. The state government will be able to manage spending and focus on other key areas of the economy. However, the implementation of this option might not result in reduced Medicaid bills since such care plans are not the primary culprits (The Commonwealth Fund, 2021). The identified choice could worsen the situation for more people in need of the identified services, such as the elderly, disabled, and those with chronic conditions.

Promoting Competition

The existence of several insurance companies, policy arrangements, and Medicaid presents a unique mix for supporting patients health needs. The state can promote competition among these stakeholders to ensure that health coverage plans remain as low as possible and available to more people. This approach will encourage citizens to identify additional insurance policies depending on their health needs. This effort will result in reduced reimbursements for Medicaid, thereby making the current bill manageable (The Commonwealth Fund, 2021). However, this model could affect the overall level of insurance coverage to persons with low-income levels.

Conclusion

Medicaid remains an important program that supports and meets the health needs of more citizens. However, states continue to grapple with increasing bills that might become unsustainable without proper financial management. Some recommendable options to reduce Medicaid costs include the promotion of a healthy competition, promoting managed care, and reducing long-term care expenses. The state can cut reimbursements, benefits, and pharmaceutical costs. Other measures could include imposing copayments, reducing fraud, increasing administrative burdens, and cutting eligibility levels. A balanced approach that considers the pros and cons of each of the proposed initiatives is critical to reduce the current Medicaid bill.

References

The Commonwealth Fund. (2021). Reducing health care spending: What tools can states leverage? Web.

Crowley, R., Daniel, H., Cooney, T. G., & Engel, L. S. (2020). Envisioning a better U.S. health care system for all: Coverage and cost of care. Annals of Internal Medicine, 172(2), 7-32. Web.

Hu, L., Kaestner, R., Mazumder, B., Miller, S., & Wong, A. (2018). The effect of Affordable Care Act Medicaid expansions on financial wellbeing. Journal of Public Economics, 163, 99-112. Web.

Jackson, M., Agbai, C., & Rauscher, E. (2021). The effects of state-level Medicaid coverage on family wealth. RSF: The Russell Sage Foundation Journal of the Social Sciences, 7(3), 216-234. Web.

Sugar, S., Peters, C., De Lew, N., & Sommers, B. D. (2021). Medicaid churning and continuity of care: Evidence and policy considerations before and after the COVID-19 pandemic. ASPE.

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