AUGUSTA, Maine — A nine-member task force charged with finding short- and long-term savings in the state’s Medicaid program drew praise Tuesday for its recommendations for long-term restructuring, restoring coverage for anti-smoking medications and adding dental benefits for patients who frequent the emergency room.
Hospital representatives, physicians, Medicaid patient advocates and others were reacting to a draft report from the state’s MaineCare Redesign Task Force, which was charged with finding $5.25 million in state Medicaid savings this budget year and recommending longer-range reforms. Maine’s Medicaid program, which provides health insurance for low-income residents, has consistently been subject to cost overruns and is facing a $100 million shortfall this budget year, which ends June 30, 2013.
The task force’s report fell short of its short-term savings target, coming up with $1.35 million of the $5.25 million sought. But health-care providers, patient advocates and others offered support for many of its recommendations Tuesday.
The state earlier this year eliminated most Medicaid coverage for anti-smoking prescription medications as part of a larger package of Medicaid reductions. The report’s recommendation to restore the coverage would cost about $530,000 annually, but advocates for the move touted the potential for even greater future savings.
“This is an area where we really ought to be investing in: getting as many people as possible to quit smoking, particularly when the research shows they’re interested in quitting,” said Ed Miller, vice president for public policy for the American Lung Association of the Northeast, who noted that 42 percent of Maine’s Medicaid recipients smoke, compared to 17 percent of non-Medicaid recipients.
Advocates for dentists and patients praised the recommendation to pay, at an annual cost of $3.15 million, for dental benefits for patients who frequent the emergency room for dental-related problems.
“We can’t separate oral health from the whole body,” said Simonne Maline, executive director of the Consumer Council System of Maine, which represents patients receiving mental health services. “We believe there are long-term savings if we can get more folks out of the emergency room and into appropriate care.”
In its 71-page report, the MaineCare Redesign Task Force estimates its money-saving initiatives will save the state $11.28 million in the 2013-14 budget year and $22.59 million the year after that.
Every dollar saved at the state level translates into additional savings for the federal government, which picks up about 63 percent of Maine’s Medicaid costs.
The task force report focuses its core recommendations on the most expensive patient populations, noting that 5 percent of Medicaid patients account for 54 percent of Medicaid costs. The most expensive patients — who often have developmental disabilities that require constant care in specialized facilities — cost the state’s Medicaid program, on average, $68,562 annually, compared to $937 for the bottom 80 percent of Medicaid patients.
The report stayed away from recommending broad-based reductions in the rates at which Medicaid reimburses hospitals and other health-care providers for treatment, a decision that drew praise.
But providers said they were concerned by other sections of the report that suggest adding to the list of hospital-acquired conditions for which Medicaid won’t cover treatment, and cutting back on Medicaid reimbursements to hospitals when patients are readmitted for the same conditions shortly after release.
“A readmission is not always due to the original care provided at the hospital,” said Arthur Blank, president and CEO of Mount Desert Island Hospital. “If a patient is discharged with pneumonia on a prescribed course of antibiotics and the patient doesn’t take the antibiotics or get the prescription filled, they’ve very likely to come back.”
Those who attended the public hearing also criticized a short-term savings recommendation in the report that would end Medicaid reimbursement to nursing homes and other residential facilities for hospital leave days — days when patients aren’t in the facility because they’re receiving hospital care. The report estimates a $160,000 savings for that change this fiscal year.
Nursing homes stand to lose crucial funding if that happens, said Richard Erb, president and CEO of the Maine Health Care Association, which represents nursing homes and other residential care facilities.
Plus, he said, the state Medicaid program is unlikely to save money if nursing home residents have nowhere to go after receiving hospital care.
“If patients become backed up in the hospitals while they wait, the estimated savings will quickly evaporate,” Erb said. “We believe this to be penny-wise and pound-foolish.”
The MaineCare Redesign Task Force plans to issue its final report to the Legislature. Any significant change to the Medicaid program requires approval — either from the state Legislature, the federal government or both — and oftentimes changes to state rules.
Do not attack the disabled, go after the mentally ill who are faking. The fact that people can state they have panic attacks and get everything free is absurd.
It’s only if they are pretending to have panic attacks, or pretending that the severity of the attacks disables them. Some people who have psychiatric illnesses are genuinely disabled .
look at the way i live tell me that to my face
I don’t understand what you mean. I was not accusing you of faking, if that’s what you mean.
sound like my sister.
people do not fake
Yes Davida, and humans never lie…
one more thing you dont get everything free.
Tell ’em you’re anxious about not getting everything free and you will. Its really very simple, i’ve seen it done.
anxiety is one of 5 primary mental health issues that interfere with life.
Everybody gets anxious. Just saying that it shouldn’t warrant a free ride. I am very familiar w/some people who have claimed “I’m anxious” and gotton free EVERYTHING and that is to what I am referring.
My uneducated guess,no actually, my educated guess is, that those who have thumbed down my comments are either on the take somehow or are those who are ripping off the system. Oh dear, now you’ve caused me to be anxious so I will go tell my doc who will send me on and I will get a diag of mh and the free ride will begin.
How about upping the co-pays? Maybe some of these folks might think twice before dragging their kids to the ER for the sniffles if they had a higher co-pay.
They need a primary physician. That’s the cost savings. The ER is the most expensive service in any medical treatment. We need to educate people and tell them, get a primary physician and set your routine up.
For scheduled visits.
Now what I’m curious about is will we be able to get marijuana with our MaineCare. And will it be cheaper then the street price. And will Maine Care offer a discount for the assorted drug paraphernalia that comes with being a dope smoker.
This has the potential to close the budget short falls in DHHS. It’s a literal gold mine of profit if the medical weed legalization becomes enacted. Then of course from there full legalization. Where talking money pouring in like Niagara.
And while the pit falls are many and the ill’s almost to horrible to mention once the public gets sucker punched with the half baked lies concocted from crooked Doctors as to marijuana’s real benefits as opposed to it’s many side effects, it never the less is a powerful tool to generate enormous revenue.
those on medicaid are assigned a primary care physician, when one is available.
Yeah, if your 65 or older. That ain’t who going to the ER it’s 30 something mama Beele and the twins. And homeless Joe.
Capt Smith strikes again.
Sounds like the has been Captain Smith is now the engineer of a run away train to nowhere.
I’m not sure I know what you are getting at, could you please elaborate .
I was thinking the former Skowheganresident….
if they COULD pay they would have their own PRIVATE insurance .
Well, that is a false assumption. Because better then half of those working who can pay don’t carry health insurance. (but not for long)
The bottom line, if you are using the ER for your non emergency medical needs you are driving the cost of health care up.
Spin it anyway you like.
So it would take some “nerve” to require somebody on Mainecare to dare have to pay a co-pay for a visit or a prescription? $3 copay? Why, I have cigarettes to buy.
some people cannot afford dental care from a dentist. when you get a fat face then you have to go to ER
LOL
I think what people are saying about dentists is that…..Bangor has a dental clinic where you pay a scale (Most the bigger cities do)…go once a year get your teeth cleaned and looked at for $15….I know, I know….thats 2 packs of smokes or 4 days of bus tickets to the methadone clinic…..look we ALL make sacrifices. If I need to go to a basic cellphone or maybe sell one of my 3 used cars (all working, nothing fancy) or maybe make it a little colder in my house due to high oil prices in keeping a quality of life for me and my 5 kids @ 45K per year, then thats what I do. If you make “0” money working and get 8-10K per year in state benefits…you also have to ‘make sacrifices’..pay a few dollars for your dentist or prescriptions and start making sacrifices that we all make….People do have a right to human misery and early death…they do not have a right to make the taxpayers fund it.
The Penguin administration will blow these suggestions out faster than a birthday candle.
yup there is no room for commonsense in this admin..
Meanwhile the Dems are going to pay the government hack jobs even more because they’re Dems now and they have experience at bilking the taxpayers. Line up the next round of crooks.
We’re paying that Dem thief Violette $60k per year for life even while he’s in jail for stealing from us.
I was going to vent but it wouldn’t make a difference..our system is soooo messed up
Maybe if dental care along with medical care was affordable more people could afford to go.
A filling costs about as much as 2 cartons of ciggs. They can’t do it much cheaper than that. A toothbrush and toothpaste costs about as much as one pack of ciggs. It’s all about priorities.
Apparently you get free dental because the last filling I had was over $300.00 and I doubt a carton or two of cigarettes cost that much.
Try a different comparison.
I don’t have free dental care or dental insurance, my last filling was $180.00
I have never had any free dental care in my lifetime. I used to pay about $50 a filling until about 5-6 years ago. I think my last one was under $150. I guess northern Maine prices might be a little lower but they are about half that much across the border. How many fillings do ya need anyway? A couple a year shouldn’t break ya too bad. I went without and did what I had to do to get my son to the dentist too. You can’t just let them fall out.
And if you have regular care and fllow good procedures you shouldn’t need that many fillings.
Try a different dentist.
a filling for $100??? I dont think so… an assessment cost more then that at the dental clinic$($150)—If you are poor you don’t have $150 – who’s your dentist?
So if the poor don’t have the $150 for dental work, then were did those three cartons of cigarettes come from?
if you’re poor, quit smoking, go to the dentist and work out a monthly payment plan with the billing department. Just because they can’t pay the 150 or 300 bucks all at once doesn’t mean they can’t get services and pay for them over time, that’s how I’ve paid for dental services for decades.
Yay, for you!
You find a dentist that takes payment plans and post it up here.
I am not even being snarky.
If there really is a dentist that will take payment plans some people I am sure would like to know.
I think your fibbing – I know someone who called all over the state a few months back and couldn’t find one.
I know for a fact High Street Dental in Bar Harbor will take payments from an established patient.
Established patients not new ones….
No one said it had to be new ones did they?
Why would they accept a payment plan from a new patient they don’t have any history with? Would you?
This is about the poor who don’t have a dentist but need one. So how is a poor person with no history get to set up payments with no money…. with a dentist who will only take payments from an established patient.
How do they get cell phones? How do they get ciggs and tattoos? It’s the same principle, you choose what you need the most and live without what you can’t afford. I see it all the time, people whip out their State debit cards and buy food that I can’t afford and get into nicer cars than I have so my sympathy isn’t what it used to be. It makes me think I am the dumb one for working.
I’m not sure if I am for or against Mainecare covering dental costs but I know the cost isn’t as much as everybody says it is.
That sounds like sour grapes and envy.
I think it sounds like someone who sees reality for what it is and isn’t afraid to say so.
It’s emotionally and physically exhausting to be you…
Like other medical care with outrageous costs – dental costs are something that are obviously an issue. Preventative care and maintenance should be classified differently than strictly cosmetic procedures and priced accordingly. Though good luck with making this happen, right?
And a good dentist will give you a toothbrush and toothpaste as you leave your visit.
It sounds like the budget is already cut to the bone if 80% of the users only average about $900 in benefits. Of course 5% of the population is severely ill and need more expensive care. That is to be expected.
I have always said every hospital should have a walk in clinic right next to the emergency room so you can direct people with a common cold away from ER and to the clinic. Just common sense.
Have fun finding a Dentist who’ll take MaineCare when/if it’s reinstated. Dentists like other Care Providers are sick of waiting for their payments to come through.
Spot on comment…..it (lack of and delays in re-imbursements) will be seen and felt in many areas of our healthcare…..
exactly, and if a dentist did decide to take on Mainecare patients and wait months to years for their payments to come thorugh, what do you think they will do to their service rates and fees as they try to compesate for the missing revenue from the state….instant price escalation
want higher dental care costs? just let the government get involved
Interesting point. I have found that those Doctors who are not solvent enough are generally the ones you should avoid. They are also the ones who generally pad the bills.
Study’s suggest that better then 5 in 10 Doctors in America are as crooked as the day is long. While better then 7 in 10 having no better understanding of medical needs or diagnosis then a 3rd world witch Doctor.
Could you please provide access to those “study’s” you reference? Thanks…..
It was a study put out by the Brooking Institute as it pertain to Medicare fraud and Doctors who are obtaing fraudulent medical credentials through online diploma mills.
You can do better than that…..provide a specific link for the “studies” you claim exist for the supposed “facts” you reference….an opinion is not what I care about but specific studies….
I’m attempting to search the archives now, stay tune. In the mean time you can help as well by doing some online research/search.
And hold on tight to what you find. There are reasons why even Americans seek out Doctors in Cuba. Who’s medical procedures rivals anything we have.
While you search let’s get back to the main point of the comment that spurred this branch of the thread…..”providers are sick of waiting for their payments to come through”…..#1) Research and find out how much monies are owed to our state’s hospitals for services and care already rendered……the answer in short is that the state owes $$ millions to several and the unpaid monies date back several years………#2) Call Miller Drug on State St……Miller’s has set the standard for providing & supplying medications and other durable medical supplies to patients in over 2/3 rd’s of our state for decades…..tell them that on Jan 1, 2013 you would like to start receiving from them medical supplies (i.e. wound care or ostomy supplies) which they have been the go to guys for and see what their answer is….the private medical provider and/or supplier is being choked off from deserved payments and re-imbursements for rendered care and we cannot expect these folks to continue to get the shaft from the system…..http://www.maine.gov/governor/lepage/issues/mainecare_reform.shtml
I hear ya. But there is a flip side as well. Double and even Triple billing and we haven’t even covered the unnecessary procedures.
Now, it has gotten longer waiting because the Fed. is now scrutinizing everything submitted. And it’s on the orders of President Obama to save the tax-payers. And AG Holden has been relentless, over $25 billion dollars over the last 4 years uncovered in fraud and saved, and Doctors losing their license and some even going to prison.
The medical industry in America is beyond corrupt. They’ll only keep you alive long enough to milk everything they can out of you.
Brilliant idea! Let’s add more handouts to a program already running a $100 million budget deficit. Great liberal think tank at work here.
And then there’s the Brilliant conservatives who insist we be a third world country concerning health care. You people are pathetic, bit..h and whine and no solutions except get a job, the turds of the right have had plenty of time to do something and they do nothing except point fingers. Your are nothing but frauds and prove it every time you run your yaps.
The only frauds in the room are the bone-headed democrats who look at a 100 million dollar shortfall and suggest we should spend MORE to make up the funding gap
Then how about a solution from the wing nut geniuses. I hear a lot of whining, lots of mouth yet no solutions, face it the clowns on the right have had plenty of time to do something about this and they do not. The only conclusion one can come to is that Allen Grayson was correct all along, the wing nuts solution “Hurry up and die”
Apparently even a semblance of accountability and personal responsibility is looked down upon. I’m all for helping people that need it, though one has to do their own part in taking care of themselves. This is not much to ask. If someone can’t be bothered to quit smoking by age 65, I think it’s pretty clear they’ve already consigned themselves to premature death or disease – seems to me they’ve already decided to “hurry up and die” all by themselves.
Those that propose “solutions” that ask nothing of the recipients are doing the collective no favors. Go ahead, smoke, drink, get morbidly obese, we’ll pick up the tab no matter what!? That’s compassion? No. It’s the opposite.
One of the un-deniable reasons our collective costs are so out of hand, are our collective lifestyles. Government can’t fix that.
The extremists on the issue – the socialist “government will fix everything!” set and the libertarian “we don’t need no government!” set are both wrong, as usual.
I think that’s a problem with health insurance in general there is no cost incentive to stay healthy. Like in auto insurance if you’re a good driver your rates go down. With health insurance regardless if your healthy or not your rates continually go up. We all know there are those who use the system continually for various reasons many can not help that, yet many can.
I have opted out of the entire mess and instead of carrying insurance try to stay fit, don’t smoke and stay away from processed food and red meat. I pay my medical needs out of pocket and never go to a doctor because the office is full of sick folks. I seldom get sick and so far have been lucky enough to keep my distance from the system. I know though its only a matter of time till that will no longer be a reality.
But till then I do yoga, use deep tissue massage, chiropractors and acupuncture. They all seem to work better for me than traditional medicine.
Until they take the profit out of health care I don’t think anything will change. Being profit driven I think the entire health care system is upside down and not in our best interests. It’s focus other than profit is to fix what is broken instead of preventing us from breaking.
Your last paragraph is right on. While healthcare providers should be compensated well, profit should never have been allowed to become the top priority.
The focus today I see as more on extension of life than it is on quality of life. Preventative care and maintenance are better investments long term than trying to correct catastrophic conditions, which in most cases are too far along to reverse. And though medical and dental have to be part of the equation, obviously the overwhelming majority of preventative care and maintenance needs to take place at home, such as you’re doing. Seems some believe the primary burden falls on the government however. The relationship needs to be reciprocal – not one way.
I agree about the extension of life, and lack of quality. I’d sooner have a bullet in the head than be a drooling vegetable, sin or not.
Somewhere along the line many who are able and not suffering from an insurmountable psychical condition have stop taking responsibility for their wellness and instead rely on this crazy system. You’re right about the reciprocal relationship, especially as we age our bodies if treated as junk will quickly turn into junk if you allow them to. All things in moderation and take care of your mind, body and soul, sell any one of those things short you had better beware.
It must be emotionally and physically exhausting to be you.
adult dental care is a crucial part of a medical plan — It keeps people from working AND on pain killers.
Spot on ! But stay far, far away from Aspen Dental. If you ever want to see what chain store medicine is all about pay a visit. But leave your wallet at home.
I went in for a consultation, and by the time I got out of there they had my whole future of dental care and hygiene all mapped out to the tune of $3k + +.
I got the same work done and the unnecessary work not done through a more reputable dentist at a fraction of the cost.
Also try to avoid Dentist who have the office receptionist flashing to much cleavage. It’s usually a dead give away they are trying to hustle ya.
Living up to your screen name? Still got all your teeth?
gjort
It would be truly wonderful if instead of being so eager to fill us full of nasty pharmaceuticals, give us what we really need as we age, Dental, eye and hearing. I guess billing insurance for pills is more lucrative then actual fixing something.
Doctors should ask their Hospital administrators to stop supporting Dufus Paul Richard Lepage’s plan to bump off as many Mainers as he can before his term in Augusta ends.
Agreed, Doctors should also ask their administrators to take a 600K cut in pay and lower the cost of health care.
42% on Maine’s Medicaid smoke? Whoa!
Need an incentive? How about quit or you’re off medicaid?
This is nothing but a subsidy handout to big pharma and the dental industry…
back to the same ol’, same ol’ from the dems in Maine, government welfare for big pharma and the medical industry under the guise of ‘investing’ and ‘savings over the long term’…..problem is the ‘investments’ merely bring more Mainers into the fold of government dependency, thereby destroying the supposed long term ‘savings’….of course the 1% in big pharma and the dental industry could care less as they plunder the system, handing out kickbacks to their financial campaign backers
So again, the finger pointing and whining but no solutions? If the clowns that oppose health care are so freaking smart why is it they have no answers?????????
LOL….no solutions? How is spending money WE DON’T HAVE a solution there genius? How is subsidizing the 1% and folks who are already financially stable supposedly going to help the poor?
the solution is simple, quit smoking or LOSE your medicaid benefits, then pay for dental services OUT OF POCKET like the rest of us. If you have a $1000 procedure done at a dental office, do like the rest of us and set up a monthly payment plan that you can afford…
no solutions…give me a break, the only people with no solutions are the munebat democrats flailing and fumbling in Augusta on day one
Yada yada yada blah blah blah.
You have all the solutions huh? Actually you don’t..
The teapublican philosophy is alive and well; “Just let the poor die to make sure there’s more for us.”
A message for the chest thumpers, JackWagons and knuckle draggers:
Many of us pay ALL our medical expenses out of pocket because the cost health insurance is insane
I have never had Dental coverage. My insurance does NOT include Dental coverage. Consequently, I floss and brush twice, sometimes 3 times a day. I would hate to think that these folks are going to get FREE dental care. Buy them a toothbrush and tube of toothpaste. Anti-smoking meds. REALLY!! Anti-Smoking Meds!! Give me a break. Where do they get the money to buy cigs in the first place? It’s all a bit ridiculous and way over the top. We’re supposed to help them for awhile, not take care of them forever.
What’s your thoughts on getting medical marijuana with MaineCare ?
In other words if you had the choice would you chose the Dental or the Weed ?
is there a doctor in the house?
I know, right? These folks with their teeth. No reason my money should be used to help these folks. I could be spending my tax money on new golf clubs, or Cognac. Who do these poor folks think they are. I’ve even got them living around ME…..
IF Maine Care offers dental?Im a going to quit my job,and start living off the state…Wow!30% discount on medical mj, AND dental??????
What about medical marijuana ? (and with the right doctor you can get in on the action if your a partaker of the mojo)
Absolutely nothing…
=======
If I had a job that allowed me to be on the BDN at 10 AM, I think I would keep it. Dental or not.
Why don’t they just add pedicures, manicures and nail extentions, tattoos and body piercings as other ways to waste TAXPAYER money.
Prevention costs less. Prevention and early detection of dental disease saves money in the long run. It isn’t a waste of money keeping people healthy.
I paid your share of taxes today, Badoog. Go get you that pedicure…..
I guess they are not making enough money with forced vaccinations of infants and the never ending lies about flu shots. Ah, but once again the profession of abortion and euthanasia proves the truth of the words of Christ: “No man can serve two masters: for either he will hate the one, and love the other; or else he will hold to the one, and despise the other. Ye cannot serve God and mammon (money an the things of money).” ACP/KJV
How about a hot apple pie with that also.(THE STATE OF MAINE IS BROKE) to all you democrats out there let me repeat(THE STATE OF MAINE IS BROKE) I would like a Cadillac also guess what Like the state of Maine i can not afford it.When are we going to help with peoples needs not their wants
Good health care is a need, so is preventative dental care.
Stop whining about poor people and how much they inconvenience you.
Bad teeth often indicate a serious illness. Had a friend who went to the dentist for a simple filling. The dentist advised a visit to the Dr. who ran tests etc…
It was cancer, they found it early and removed it.
I never did understand why teeth and feet were severed from the rest of the body as far as health insurance went. It’s not like those parts don’t count. Just ask anybody in pain.
In the state where I used to live, most hospitals had beds that were considered to be skilled nursing care beds. Patients waiting for nursing home placement, or those not ready to be discharged to home were placed in those non acute beds and insurance companies/medicare/medicaid were billed at the lower rates.