Rural America and New Medicaid Rules
Using three rural counties as lab rats, West Virginia plans to adopt a plan that would punish some Medicaid recipients - even for factors beyond the control of patients in need of care. The New York Times explains:
Under a reorganized schedule of aid, the state, hoping for savings over time, plans to reward "responsible" patients with significant extra benefits or - as critics describe it - punish those who do not join weight-loss or antismoking programs, or who miss too many appointments, by denying important services.
The incentive effort, the first of its kind, received quick approval last summer from the Bush administration, which is encouraging states to experiment with "personal responsibility" as a chief principle of their Medicaid programs. Idaho and Kentucky are also planning reward programs, though more modest ones, for healthful behavior.
While supporters tout the new rules for encouraging responsibility, the Times notes that it is "not clear" in the written plan "that doctors will be able to provide medically necessary drugs and care to children even if their parents have not followed the agreement." The New York Times also noted other problems with the program:
A stinging editorial in The New England Journal of Medicine on Aug. 24 said it could punish patients for factors beyond their control, like lack of transportation; would penalize children for errors of their parents; would hold Medicaid patients to standards of compliance that are often not met by middle-class people; and would put doctors in untenable positions as enforcers.
"What if everyone at a major corporation were told they would lose benefits if they didn't lose weight or drink less?" said a co-author of the editorial, Dr. Gene Bishop, a physician at Pennsylvania Hospital in Philadelphia.
Even though supporters claim it's about promoting responsibility, the NY Times quotes a woman pointing out that "some people can't afford the transportation to go to these programs."
Rural America will feel much of the pain, given the lack of public and affordable transportation. In fact, according to the Rural Institute, a lack of transportation was labeled one of the "most difficult problems" for rural residents. As a result, the policy will take direct aim at medical care for rural families unable to keep up with the demands these rules require for full benefits.
