On the  Alabama statewide webportalblogthingy (al.com), the Alabama Policy Institute weighed in on Medicaid. For those who are not from Alabama, the API is a “non-profit research and education organization dedicated to the preservation of free markets, limited government and strong families.” Or, in other words, a voice for even purer conservatism in a deeply conservative state. The API’s take on the situation is as follows:

For being [the second largest budget] expenditure, the average Alabamian might believe the state’s Medicaid beneficiaries receive some of the most generous health care around. Unfortunately, that is not the case with Alabama Medicaid. The state’s Medicaid program provides few services not mandated by the federal government and has some of the strictest eligibility requirements in the country.

The API goes on to identify the problem and propose a solution:

While the current [fee-for-service] system provides “on demand” access to health services, it merely treats individual health symptoms rather than developing a comprehensive approach to long-term beneficiary care. There are two primary solutions that make sense: require accountability from providers for beneficiary outcomes and shift the risk of financial loss away from the state.

APIs seeks an end point solution (beneficiary care coordination and risk protection for Alabama) and proposes a solution (commercial managed care).

The Governor appointed a commission to proposal a path leading to the same endpoint whose final report was issued last month.

The Commission on Medicaid found eligibility that was severely limited, a complex funding structure, and a myriad of perverse incentives. This has resulted in a system that is an efficient rain maker (for every $1 of real money put in by the state, the feds give back $9 in return) but the health of the citizens of Alabama suffer (too many emergency room visits, not enough primary care visits) as a consequence.

Both the Governor’s commission and API find that beneficiary care coordination and risk protection for Alabama are important. The commission was not as optimistic as API about the ability of commercial companies to deliver on this promise. They looked at Kentucky and other states where the commercial companies have come in, disrupted the existing care delivery system, left after “profit taking” for several years The down-side was that the poor, sick people were still poor and sick and in Kentucky after the company left. The commission, instead, recommended that Alabama be divided into regions and that a community led network in each region coordinate the health care services of the Medicaid patients in that region. These regional care networks will formally engage consumer input and oversight at all levels of governance and operation and ultimately assume risk, providing risk protection for the state. This was proposed, in part, because we could use the profit commonly provided to the commercial companies to delivery real and tangible services to folks.

So, agreement that there is a problem that requires a creative solution. Proposed solutions from several camps on how to continue to provide care (perhaps even expended care) to poor Alabamians. Could we be next to announce a change in Medicaid?