A great magician performs their tricks right before your eyes – while they have you looking somewhere else.
On Friday, January 8th (as most of us watched the recovery from the Capitol riot) the Centers for Medicare and Medicaid Services approved a waiver to let Tennessee fund Medicaid through a block grant instead of reimbursement for direct costs.
I know, that sounds wonky.
Bottom line: with a block grant a state gets less oversight from Washington on where the money goes. And, a state can restrict care when that set amount of money runs out.
For example, the waiver lets Tennessee control what drugs its patients will get. From remarks by CMS fuehrer Seema Verma…
Specifically, the state will have authority not to cover certain medications when there is at least one drug available per therapeutic class under essential health benefit rules (with the exception of certain protected drug classes), and to exclude certain new drugs from its formulary, with an exceptions process for specialty drugs. —https://www.jdsupra.com/legalnews/cms-reneges-on-historic-grand-bargain-2534740/
Huh?
Basically, the state – not your doctor – will determine what drug you get for your issue even if your doctor knows that the ‘approved drug’ isn’t the best for you, or the approved drug has proved ineffective with you. The exclusion of new drugs, for example, could have been used to deny people penicillin because sulfa drugs had proven effectiveness against most infections.
Meanwhile back in Missouri…
Voters approved – over the governor’s wishes – an expansion of Medicaid which will give hundreds of thousands of our neighbors access to health coverage. And, the expansion should limit the state’s ability to kick people off of coverage (remember those 100,000+ kids the state lost?).
After his accidency’s inauguration this past Wednesday, a TV reporter asked Mike Parson about Medicaid Expansion.
With Medicaid expansion, he said his team will have to figure out how to save through the cost side of it or how to change the program in order to save enough money to pay for it. — Gov. Parson discusses COVID and Medicaid after inauguration | Elections | komu.com
‘How to save through the cost side of it.’ In other words, rather than expand the program’s resources to handle all those to be covered, the governor wants more cost control. That’s consistent. Back in 2019 McKinsey – a very for profit consultant group – did a study for Parson and concluded that Missouri ought to adopt ‘alternative payment models’ for Medicaid service providers. In other words, pay them less and make Medicaid patients less attractive to health care providers.—https://missourihealthcareforall.org/wp-content/uploads/2019/11/MHCFA-McKinsey-Summary.pdf
So, how can a governor who hates Medicaid lower cost? How about getting a block grant waiver?
True, Joe Biden stated that he stands against waivers and other cuts. But Tennessee’s waiver doesn’t expire for 10 years. And, one waiver can be used as leverage for a second, third or 20th – even when the president hates waivers.
So, remember January 8, 2021 as the day Medicaid began to die.
Glenn