Not-for-profit health insurers warn Medicaid cuts would endanger essential care-management programs

Not-for-profit health insurers warned Monday that federal Republican lawmakers' proposed Medicaid funding cuts would endanger programs essential to caring for members who are elderly, disabled or suffering from substance use disorders.

Vulnerable Medicaid members would go without necessary care and some would even lose coverage, driving up the cost of uncompensated care at hospitals throughout the states, medical directors at regional health plans Geisinger Health Plan and UCare said during a teleconference organized by the Alliance of Community Health Plans, which represents not-for-profit insurers.

"Federal money is the linchpin to make all this work," said Lisa Mattson, associate medical director at Minneapolis-based insurer UCare, referring to UCare's care-management programs. "We really can't do it all alone on our state budget."

The GOP's American Health Care Act, passed by the House in early May and currently being revised by the Senate, would convert Medicaid from an open-ended entitlement to a system of per capita or block grant payments to the states. Those payments would grow at a rate below projected increases in actual Medicaid costs.

The bill would also phase out enhanced federal payments to the states for the Affordable Care Act's expansion of Medicaid to low-income adults and reduce federal Medicaid spending by $834 billion over 10 years—cuts that Alliance of Community Health Plans CEO Ceci Connolly said were very concerning. She added that the proposals to convert Medicaid to a per capita cap system do not account for costs from a public health epidemic, the opioid addiction crisis or an aging population.

The slashed Medicaid funding would mean UCare's 250,000 Medicaid enrollees may experience an increase in cost-sharing and reduction in healthcare services available, Mattson said. Some UCare Medicaid members may lose coverage, which would drive up the amount of uncompensated care provided by Minnesota hospitals, some of which have already closed because of rising healthcare costs, she said. Hospital uncompensated care decreased by nearly 17% in the first two years of the ACA, according to the Minnesota Department of Health.

Most of UCare's Medicaid dollars go toward serving the elderly and disabled members, Mattson said. The health plan works with local community organizations to reach members and encourage them to seek necessary medical care. Its mobile dental clinic, a 43-foot-long bus equipped with dental chairs, provides dental checkups and restorative care to UCare members across Minnesota.

Medicaid funding cuts would "drastically impact those types of programs and lead to a decrease in the health of our community, and probably increase in the overall cost of healthcare," Mattson said.

Danville, Pa.-based provider-owned plan Geisinger, which serves 190,000 members on its Medicaid plan, launched its first ambulatory clinic to provide medication-assisted treatment, or MAT, to members dealing with substance use disorders about two months ago. Sixty patients have enrolled in the program to receive treatment, with a waiting list of three weeks, said Dr. Perry Meadows, the plan's medical director of government programs. MAT combines medication and behavioral health therapy to treat addiction.

"Quite honestly, if Medicaid disappears, this program will disappear," Meadows said, adding that without Medicaid coverage for substance abuse treatment, "We're going to be losing lives."

Medicaid managed-care plans are already stretched thin. Margins on the line of business hover around just 2% nationally. Medicaid covers about 76 million people. Almost three-quarters of those beneficiaries are enrolled in plans managed by private health insurers.

"We all have to remember that we're not talking about population, we're not talking about a number on a spreadsheet," Meadows said. "We're talking about the health and quality of life of people just like us."