Report: Medicaid Care Hurt by Differences Among State Programs
There is wide variation among state Medicaid programs' eligibility requirements, benefits and quality of care, according to a report released on Wednesday by the advocacy group Public Citizen, CQ HealthBeat reports.
The report analyzed 2004 and 2005 Medicaid data compiled by the Kaiser Family Foundation Commission on Medicaid and the Uninsured, as well as independent data collected by Public Citizen, ranking state Medicaid programs based on the extent to which they surpassed federal coverage mandates. The scores were divided into four categories: eligibility, scope of services, quality of care and provider reimbursement.
The analysis is an update of a 1987 report by Public Citizen (Carey, CQ HealthBeat, 4/18).
According to the report, eligibility and service standards are not consistent or portable across states. In addition, the report found that states vary widely in deciding whether to offer optional benefits not required by federal law.
Overall, states scored the lowest on the quality of care provided, according to the report. To measure quality of care, Public Citizen examined indicators that quality care is being delivered, such as nurse-to-patient ratios in nursing homes and childhood immunization rates (Public Citizen release, 4/18).
The 10 lowest-scoring states were:
- South Dakota;
- South Carolina;
- Alabama; and
The top-ranked states were:
- Rhode Island;
- New York;
- Washington state; and
- New Hampshire (CQ HealthBeat, 4/18).
According to the report, the Medicaid system is "a bleak picture for millions of people" who need health care. The report said that there is "not much 'aid' in Medicaid" and that the national variance in the Medicaid program leaves millions of U.S. residents with inadequate access to health care coverage and few physicians from which to receive care (Song, Seattle Times, 4/19).
Sidney Wolfe, director of the Health Research Group at Public Citizen and co-author of the report, said that "federal standards are so inadequate that no state has a truly excellent Medicaid program" (Groppe, Indianapolis Star, 4/19).
According to Wolfe, unless Congress moves to correct inequalities, Medicaid "will keep getting worse and worse ... disparities will worsen" (CQ HealthBeat, 4/18). He added that the program should be standardized nationwide (Augé, Denver Post, 4/19).
Annette Ramirez Arellano, a public health expert with Public Citizen and co-author of the report, said, "Where you happen to live can make all the difference," adding, "Most people on Medicaid face hurdles to eligibility and an uneven patchwork of services because practically all states have deficiencies in one or more of these areas" (Public Citizen release, 4/18).
Dennis Smith, director of CMS' Center for Medicaid and State Operations, said that the report "misses the fundamental nature of Medicaid and 40-year history that states have authority to administer program within (a) federal framework." He added that the Medicaid changes included in a budget-savings bill that became law last year "have been fully realized" and will allow states to "create programs that are more aligned with today's Medicaid populations and health care environment" (CQ HealthBeat, 4/18).
The report is available online. Note: You must have Adobe Acrobat to view the report.