In response to the editorial board comments of Nov. 21, “Governor adds pricey consultant to political staff,” while I agree there are questions surrounding the no-bid contract, I also believe that an in-depth review of the MaineCare system is required and could lead to savings moving forward.
Whether you believe in expansion, status quo or further cutting the eligible population, I think we’d all agree that any department that spends roughly one-third of our state’s budget should be audited by someone outside the agency and we should be looking for savings, efficiency and program integrity.
It’s long been debated whether MaineCare is a health insurance plan or a social assistance program, as it has components of both. Perhaps the time has come to review and restructure so each has specific accountabilities and actions allowed.
First, break out the medical reimbursement component only (“insurance”) and allow a base eligibility that mirrors what commercial insurance would provide and still allow the minimal copays those clients currently pay.
That base plan is what most low income working, disabled and/or non-working Mainers would qualify for depending where eligibility is set. Expecting prior authorization and limitations similar to other carriers with allowance for appeals must also be required.
Other plans can then be designed based on population subsets, including those who have Medicare or other coverage primary, or for those institutionalized whose care and needs are different.
The plan should also pay like a commercial carrier with payment structures that take into account place of service, type of servicing provider and other factors. Eligibility reviews should be done on a regular basis to ensure only those still in need are being helped.
Second, services such as case management and transportation should be reviewed separately and decisions made as to who qualifies for that additional service. By specifying who is eligible and what limitations they have you greatly reduce the risk of fraud and abuse.
As an example, not everyone on MaineCare needs transportation, yet the new transportation service pays a fee per member per month to the transportation carrier – that could be seen as money provided when no services will be used.
Lastly, a review of all internal costs, including staffing, overhead and other expenditures must be reviewed for efficiency. Should our state decide to expand MaineCare, those costs would not be captured by the federal government reimbursement. Savings are immediate whether you expand, contract or make no enrollment changes.
It is time to build a better system, saving taxpayer dollars while still providing a safety net for those most in need, and it will take bipartisan leadership to do so.
Robert Reed, Lewiston
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