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Now, tougher decisions are on table for states
When a program funded through state-only dollars is targeted for reduction or elimination, there is a possibility that it can be funded through Medicaid instead, notes Patricia MacTaggart, a lead research scientist and lecturer in the Health Policy Department at George Washington University in Washington, DC.
"This results in the need for less state dollars because of the federal match. But most of these type of 'fixes' have been made in previous years," says Ms. MacTaggart. "Now states, providers, and enrollees face tougher decisions."
The question is whether a program can present payment methodologies or service delivery innovations that will allow the care to be delivered more efficiently and effectively, says Ms. MacTaggart.
"There is always the limitation of time and knowledge, but most states do their homework regarding fiscal impact," says Ms. MacTaggart. "There are political and practical realities that result in changes being made before the full impact of the previous change can be fully analyzed."
There is always the possibility that a program can successfully lobby to prevent its elimination, says Ms. MacTaggart. "However, the program may be competing with other evidence-based, cost-saving programs in a time where the immediate funding is problematic for all of them," she notes. "Many excellent programs save money over time, but don't always do it in the initial fiscal year."
Programs should not be focused on in isolation, says Ms. MacTaggart. "States don't buy programs. They buy services that prevent and address health care issues," she says.
Viable programs must address how they fit into the evolving payment and service delivery models, says Ms. MacTaggart, and incorporate health information technology into their approaches to improve quality and administrative efficiencies.
In some cases, though, a program can reduce immediate costs through reductions in admissions or readmissions to hospitals, emergency rooms, or nursing homes or has an impact on high-cost, high-risk publicly funded enrollees, notes Ms. MacTaggart.
In this case, says Ms. MacTaggart, "the cost consideration changes from the cost of doing to the cost of 'not doing.' In these tight fiscal times, there aren't easy or necessarily great options to choose from. "Hard decisions are reality."
Contact Ms. MacTaggart at (202) 994-4227 or Patricia.MacTaggart@gwumc.edu.