7/30/2019 Bennett Katz - Prescription for Medicaid, KJ 1996

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JOUJUfAL. OPINION

Prescription for MedicaidI n the year just ended, Mainespent $969,600,000 on a singleprogram - not quite as muchas we spend on our public schools(kindergarten through 12), butmore than seven times as much aswe spend on the University ofMaine System. The program isMedicaid.Medicaid is a federal-state partnership in Maine that goes backover 30 years. About 75 percent ofthe dollars flow to support healthcare needs of the elderly and disabled, but there are no age requirements for low income people and,in Maine, it tonches the lives ofthousands of children. While mostpublic attention is focused onMedicare, it is the Medicaid that istearing huge chunks out of thestate budget.Because state appropriations aremalched about 2 to 1 by federal dollars, a cut in state dollars has a disproportionate effect on services bythe state . Nonetheless , si nce thelast years of the McKernan administration's budget crunch, the statehas made an aggressive effort tomake cost savings by changing e ligibility and by funny money financing.Maybe I am a Grinch to holdMedicaid up to public scrutiny atthis season. From a compassionatepoint of view, it touches the lives ofsome of our most vulnerable people in a host of ways that shouldgive us a sense of sa tisfaction thatwe are indeed our brothers ' keepers.But from a fiscal point of view, itis eating us alive, and we do notseem to have the will or answers toget it under control. There ar eabout 9.000 nursing home beds inMaine and only about one-third of

Viewpoint

BennettKatzKJ EkJaraof ~ O u t o r s

the patients are private payers.The rest, overwhelmingly, ar eMedicaid.Private insurance for long-tennca re is so expensive that rew people bave it. Greg Gravel, who runsKennebec Long Term Care 's twonursing homes in Augusta, tells methat a semi-private room costsabout $45,000 a year.Why are there so rew older nursing home residents who can affordto payout of their savings or out ofthe equity in the homes to whichthey will never return?The an swer is partly transference of assets. What aged mommadoes not want to leave the kids anes t egg? So she gilts or somehowconveys title to he r assets to he rchildren, leaving herself purposelydestitute and able to qualify (orMedicaid. As long as assets areconveyed at least 30 months priorto inslilutionaJization, it is apparently legal.That's the way the ball game isplayed and it is so prevalent thatthere appears to be no social stigma attached.Do you see the pictures of Amer-ica ns celebrating birthdays of 100years or more on the 1oda." program on NBC? We have many ofthese truly remarkable people inMaine and the percentage of 85

and older population is higher thanthe national average.As Congress ha s tightened thescrews with difficult regulationsand as our population continues toage, we appear to be running fa ste rto stay in the same place.I had a long talk with FrancisFinnegan, who runs the programfor Maine. I have known Fran sincehe was a little kid in Augusta and Ihave grea t comfort that we are insuch capable hands. He tells methat we have one or tbe most generous programs in the nation,despite our low per-capita income.Controlling future costs is notgoing to be easy for two reasons.First, because we have no quickflX, easy answers and, second,because people are going to behurt, both providers of services andthose whom we serve. This spellspolitical trouble and requires substantial political courage.I wrote this article knowing thatMedicaid is as enormously complicated as it is expensive. I think thatit is essential that we talk about itmore and tr y to understand it better . A two-minute segment on the 6o'clock news isn' t going to helpmuch. Advocates of unlimited entitlements or balchet-wielding legislatures aren't the answer. Medicaid touches the lives of so manyMaine people, does so much goodand costs so outrageously muchmoney that discussion should be atthe people level.I'm going to invite Finnegan tospeak to tbe Augusta Kiwanis .Clubas a starter. Then , I'm going tochallenge the KJ to do a major feature series on it. If my columndoes n' t appear anymore, you 'llknow that I got fired for being toopushy.

7/30/2019 Bennett Katz - Prescription for Medicaid, KJ 1996

2/2

JOUBNAL. OPINION

Prescription for MedicaidI the year just ended, Mainespent $969,60j),00j) on a single. program - not quite as muchas we spend on our public schools(kindergarten through 12), butmore than seven times as much aswe spend on the University ofMaine System. The program isMedicaid.Medicaid is a federalstate partnership in Maine that goes backover 30 years. About 75 percent ofthe dollars flow to support healthcare needs of the elderly and dis-able

Maine, it touches the lives ofthousands of children. While mostpublic attention is focused onMedicare, it is the Medicaid that istearing huge chunks out of thestate budget.Because state appropriations arematched about 2 to 1 by federal dollars, a cut in state dollars has a disj>roportioDate effect on services bythe state. Nonetheless, since theast years of the McKernan adminstration's budget crunch, the stateas made an aggressive effort tonake cost savings by changing eliby funny money financ-

I am a Grinch to holdup to public scrutiny athis season. From a compassionatejioint of view, it touches the lives of. me of our most vulnerable peoIe in a host of ways that should. e us a sense of satisfaction thatar e indeed our brothers' keep;, But from a fiscal point of view, itis eating us alive, and we do notseem to have the will or answers toget it under control. There areahaut 9,000 nursing borne beds inMaine and only about one-third of

Viewpoint

BennettKatz)(J Boardof t r l b u t ~

the patients are private payers.The rest, overwhelmingly, ar eMedicaid.Private insurance for l o n g t e r mca re is so expensive that few people have it. Greg Gravel, who runsKennebec Long Term Care's twonursing homes in Augusta, tells methat a semi-private room costsabout $45 ,00j) a year.Why are there so few older nursing home residents who can affordto payout of their savings or out ofthe equity in the homes to whichthey will never retum?The answer is partly transfer-ence of assets. What aged mommadoe s not want to leave the kids anest egg? So she gifts or somehowconveys title to he r assets to herchildren, leaving herself purposelydestitute and able to qualify forMedicaid. As long as assets areconveyed at least 30 months priorto institutionalization, it is appar-enUylegalThat's the way the ball game isplayed and it is so prevalent thatthere appears to be no social stigma attached.Do you see the pictures of Amerieans celebrating birthdays of 100years ,or more on the Today program on NBC' We have many ofthese truly remarkable people inMaine and the percentage of 85

and older population is higher thanthe national average.As Congress has tightened thescrews with difficult regulationsand as ou r population continues toage, we appear to be running faste rto stay in the same place .I had a long talk with FrancisFinnegan, wbo runs the programfor Maine. I have known Fran sincehe was a little kid in Augusta and Ihave great comfort that we are insuch capable hands. He tells methat we bave ODe of the most generous programs in the nation,despite our low per -capita income.Controlling future costs is notgoing to be easy for two reasons.First, because we have no quickflx, easy answers and, second,because people are going to behurt, both providers of services andtbose whom we serve. This speUspolitical trouble and requires substantial political courage.I wrote this article knowing thatMedicaid is as enormously complicated as it is expensive. I think thatit is essential that we talk about it

more and try to understand it better. A two-minute segmen t on the 6o'clock news isn 't going to helpmuch. Advocates of unlimited entitlements or hatchet-wielding legislatures aren't the answer . Medicaid toucbes the lives of so manyMaine people, does so much goodand costs so outrageous ly muchmoney that discussion should be atthe people level.I'm going to invite Finnegan tospeak to the Augusta IGwanis.Clubas a s tarter. Then, I'm going tochallenge the KJ to do a major feature series on it. I f my columndoe sn't appea r anymore , you'llknow that I got fired for being toopushy.

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