Friday, April 20, 2007

Wisconsin Medicaid Ranked 5th Best in Nation

This ranking is according to a new study by the advocacy group Public Citizen, which looked at four factors in its analysis: eligibility, scope of services, quality of care, and provider reimbursement.

Breaking down the scores, Wisconsin ranked 9th on eligibility, 14th on scope of services, 16th on quality of care, and 9th on reimbursements. The overall ranking of 5th came because, as the report put it, "Wisconsin's Medicaid program is unusually consistent across the board."

To put the rankings in perspective, the study found that even the top ranking states aren't doing all that well with their Medicaid programs. The top possible score was 1000, and the top ranking state, Massachusetts, came in with a score of about 646. Wisconsin scored 607. At the bottom was Mississippi at 318, Idaho at 325, and Texas at 336.

It seems the key to the rankings are reimbursements. The top state for reimbursements is Alaska, but, not coincidentally, Alaska also ranks toward the bottom on eligibility and scope of services because it limits participation and the services it reimburses. The same is true for almost all of the top 15 states for reimbursements; of those fifteen, only Wisconsin and Nebraska also rank in the top 15 for both eligibility and scope of services.

Even the top overall state, Massachusetts, ranks high on the first three measures but comparatively low on reimbursements at 23rd. Wisconsin and Nebraska stand out for being able to put together a remarkably consistent Medicaid program. Nebraska is in the top 15 in all categories, and Wisconsin only misses on the quality of care measure where it ranks 16th.

These high rankings for Wisconsin are directly correlated with the fact that our state places a high priority on funding for health care. Along with K-12 education, health care is consistently at the top of state expenditures each year.

Nevertheless, even in states like Wisconsin and Nebraska, as long as Medicaid patients remain separate from other payers in the system, they will be treated differently.

For instance, while Wisconsin reimbursements are high compared to other states, they're still low compared to those in private insurance plans. This not only increases costs for those in private plans -- insomuch that Medicaid reimbursements come in under the actual cost of the care -- but it also makes care, particularly non-immediate care, more restrictive for Medicaid patients because providers are more reluctant to accept patients that bring lower payments.

As an example, a 2005 study found that Medicaid patients were able to easily and quickly secure emergency care follow-up appointments 34 percent of the time, while those in private plans were able to do so 64 percent of the time.

It's time to start considering universal coverage plans that work to phase out Medicaid by lumping those patients in with the rest of the payer population. The state will still need to subsidize those who can't afford coverage on their own, but at least that coverage will come on a level playing field with other patients while simultaneously offering more payment consistency for providers.

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