America’s Medicaid challenges reach well beyond finances and budgets. A “money only” policy debate will quickly become counterproductive and result in a power struggle between the federal government’s charge to spend less and the state governments’ maneuvering to leverage more out of the federal government.
To achieve real transformation in Medicaid, government leaders must wrestle with the fundamental problem: one program design cannot meet the needs of such distinct and separate groups of beneficiaries – the frail elderly, the poor, and people with disabilities. They are radically different groups with radically different needs and they need radically different program designs.
Therefore, Medicaid should be divided into three distinct sub-programs, each administered separately with its own rules and structures. However, all the sub-programs should be based on the following principles:
A 21st Century Medicaid System will focus on wellness, prevention, early detection, and independent living.
A 21st Century Medicaid System will integrate the family and community into the healthcare and the lives of loved ones.
A 21st Century Medicaid system will leverage innovations in science and technology, quality systems, and best practices in every aspect of providing care for its beneficiaries.
The first sub-program should be a Capabilities Program, designed with a mission to serve people with disabilities by allowing them to lead the fullest possible lives. The Capabilities Program would capitalize on technologies and therapies that maximize beneficiaries’ abilities – not their disabilities – and put a high value on their integration into social, family, and work life without losing all their benefits. In addition, capabilities life savings accounts and other tax incentive savings vehicles should be created so the parents of children with severe disabilities would be encouraged to put money aside for the care of their children when they reach adulthood.
The second new program would address the needs of the relatively healthy poor who have much different needs than people with disabilities or the elderly who are frail. Poor individuals should be offered vouchers for health savings accounts that sensitize them to the benefits of prevention, wellness, and early detection.
The third part of a 21st Century Medicaid Act would create a program to serve the poor frail elderly. This program should integrate modern information technology systems, home diagnostic equipment, real time monitoring, and rapid health assistance to support the elderly living independently for as long as possible. For the frail elderly who must live in long-term care facilities, the new program should reintegrate the family into eldercare by allowing them to subsidize Medicaid’s contribution to the facility which would help not only financially but would also improve the quality of life and quality of care for the patient. If combined with a transition to the best uses of information systems, electronics and the most modern therapies, it could lead to a revolution in the quality of care for the frail elderly in the next decade.
A Medicaid system divided into these three sub-programs would dramatically improve health outcomes and quality of life for both individuals and their families, while simultaneously producing substantial savings for the federal and state governments.
- Newt Gingrich 2005