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Success in budgeting
July 7, 2011 

Making changes in the Medicaid program always is a delicate juggling act involving costs and the widely different needs of beneficiary groups and providers of health-care services. Reformers face the test that they not create new problems while trying to fix existing ones. 

It is a big credit to Gov. John Kasich, his Office of Health Transformation and the Republican-controlled legislature that the new state budget launches reforms that promise to improve the structure and services of Ohio Medicaid. On the whole, the budget legislation moves the health-care program for poor families, the disabled and the elderly poor a long way toward greater efficiency in finances and services. Not least, the reformers avoided the typical reflex at the first sign of budget trouble: slashing optional but critical benefits such as dental and eye care for the poor. 

It has long been recognized that in structure and operation, Ohio Medicaid, which spent more than $18 billion in total this past fiscal year, is fragmented, the quality of care uneven and spending skewed heavily to high-cost institutional care for a small percentage of disabled and elderly clients. 

Kasich set the right priority to realign the program, with the aim to coordinate better the care of the 2.2 million Ohioans the program serves, thereby lowering costs and raising the bar for quality. The budget, for instance, provides funding to establish a pediatric accountable care system that would enable the state to contract with managed-care insurers to provide comprehensive care for disabled children with special needs. To that end, the budget also paves the way for Ohio’s children’s hospitals to become accountable care organizations, able to contract for the specialized care of children with fragile health. 

Similarly, various measures in the budget legislation advance integrated care of seniors and adults with disabilities and multiple chronic illnesses. Funding to implement concepts such as health homes and an Integrated Care Delivery System promises patients easier access in a single setting to services for their physical and behavioral health care as well as other social needs. 

The budget also significantly expands options in long-term care. It thus goes some distance to address the longstanding problem of seniors defaulting to nursing homes because of the limited availability of slots for home and community-based programs. The legislation creates a unified budget for long-term care. It combines five popular waivers for home and community based services, increasing funding for these options by $532 million and opening up space over the next two years for an additional 12,890 Ohioans to receive long-term care, cheaper, in the settings they prefer. 

To be sure, much gnashing of teeth accompanied the legislative process. In the end, it achieved better care for poor families, seniors and disabled. 

Read it at Ohio.com

 



 
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