This commentary originally appeared in The Monitor on August 28, 2016 .
At a Managed Medicaid Town Hall meeting in May, state Sen. Juan “Chuy” Hinojosa, D-McAllen, heard numerous concerns about Medicaid reimbursement (payment) schedules and the large losses that McAllen area hospitals are experiencing when these institutions care for Medicaid patients.
Unfortunately, the solution proposed — more working groups, new committees and additional taskforces — won’t fix what’s wrong.
What happens when you have a computer glitch? A geek comes in and puts on a patch. That fixes the original problem but creates a new one. The new problem requires another patch, and so on and so on until the whole thing collapses with patches on top of patches. The way to solve any problem is to fix the root cause.
The Medicaid Waiver, while well intended though it may be, is a patch. It is not a fix. The primary problem is this: Providers and hospitals experience huge losses when they deliver services to Medicaid patients. They either don’t receive reimbursement for years or don’t get paid at all.
The losses are a symptom. The root cause is the monster that is a federally mandated bureaucracy for authorization and verification, coding and billing, monitoring and reporting, and compliance plus oversight. The solution is to streamline and simplify the process so the hospitals get paid what they are due, on time.
Without huge losses, there would be no Uncompensated Care Pools and no need for Texas Section 1115 Transformation waiver, much less more “working groups comprised of lawmakers and health administrators” who will only pass more new, complex rules and regulations that add to a bureaucratic maze.
We shouldn’t throw more Texas dollars into an incredibly inefficient healthcare bureaucracy. We should make Medicaid more dollars efficient. This means that more dollars would go to hospitals and providers, and fewer dollars going to the bureaucrats.
Given the current low Medicaid reimbursement schedules, more than 30 percent of American doctors can’t afford to care for Medicaid patients. If more Texas Medicaid dollars were available to pay doctors and hospitals, more Medicaid patients could actually get care. What good is having Medicaid coverage, or any insurance for that matter, if you can’t get timely care?