Medicaid has many complexities

Most people likely know something about Medicaid — the joint federal and state medical assistance program for the poor. What they think about it varies widely, ranging from a costly, welfare-like government program, whose growth seems out of control, to a compassionate, publicly funded effort to help those most in need of health and nursing home care but who can't afford it.

The truth, of course, lies somewhere in between. A recent Deseret Morning News article, "Utah's fiscal '07 Medicaid bill: $267 million" (Nov. 18) itemized what seem to be extraordinary costs and annual increases in spending. It did not, however, provide a sense of perspective; for example, how our costs compare with other states and how much effort has been invested in prudent management and legislative oversight.

The following recent data and developments may help balance the divergent views of Medicaid:

1. Utah spends 7 percent of its general tax revenues for the Medicaid program (49th out of the 50 states — only Mississippi spends less) according to recent information published by the Kaiser Family Foundation.

2. The increase in Utah's Medicaid budget from state-appropriated funds for 2007 was only 4 percent (not the 11 percent reported in the Deseret Morning News article).

3. Enrollment in Medicaid has declined steadily over the last 19 months, reflecting in part the remarkable improvement in Utah's economy in recent years.

4. Contrary to what was reported in the Deseret Morning News, a preferred drug list was approved by the Legislature last year and is currently being implemented. The PDL is already yielding significant savings in prescription drug expenditures.

5. Medicaid reimbursement for doctors and dentists has been quite low in Utah as compared to other states, limiting some of the options available to Medicaid patients. However, this low rate is also being addressed by the governor and Legislature, who together have recently increased reimbursement rates and will likely continue to do so.

6. The state Legislature established a Medicaid Interim Committee in 2005 that has met regularly over the past two years. Committee members have reviewed in detail many aspects of this complex program: Who should be entitled to benefits; what types of benefits should be covered; where benefits are best provided. The committee has also considered many of the options available to save money while preserving quality of care. Such oversight is necessary and commendable and no doubt responsible for significant improvements and cost savings.