SALT LAKE CITY — Medicaid advocates plan to help lawmakers find ways to recoup monies lost to fraud and waste in order to earn favor for certain programs that need funding this year.
Recent legislative audits found, among other discrepancies, that various providers were "up-coding" services to patients covered by Medicaid, getting reimbursed for more than what should have been required.
It doesn't help that so much was lost in a year when Medicaid enrollment is at its highest and needs the most.
"Medicaid is starting out in the hole this year," Utah Health Policy Project director Judi Hilman said during a strategy meeting held Monday at the University of Utah. "There's just not a lot of money to work with."
She's hoping lawmakers can find money this year to fund speech and hearing care for Medicaid patients, as well as eyeglasses for covered adults.
One of the ways the group hopes to help the state save money is by instituting a Medicaid preferred drug list for psychiatric medications, making it easier for Medicaid to negotiate better rates for certain drugs that are used more often.
It is proposed that a bill being carried by Sen. Allen Christensen will amend a current list, which saved Medicaid more than $20 million on the more than $100 million it spent on medications in 2010. Psychiatric medications are currently excluded on the list.
Dr. Raymond Ward, who serves on the state's Pharmacy and Therapeutics committee within the Utah Medicaid program said that the state spent $59 million on psychiatric medications last year, which makes up about a third of the total drug costs for the state, so it would "make sense" for the state to include them and save money.
Another idea, presented by Leon Hammond, director of the Utah Partnership for a Healthy Weight, was to increase emphasis on preventing chronic conditions. He said Medicaid costs are about 75 percent higher for patients with risk factors for obesity, adding unnecessary millions of dollars every year that could be saved or spent on prevention.
"It's really a win-win strategy for personal well-being and state fiscal prudence," Hammond said.
Sen. Ben McAdams, D-Salt Lake City, is carrying a bill that would create a "whistle-blower clause," providing an incentive for people who find and report fraud within the system. The state is also looking to develop a computer program that would detect up-coding electronically.
Among other ways to save the state money, lawmakers are seeking to create the office of Inspector General, a person that would oversee and officiate Medicaid.
"We're paid to really think about tomorrow and the coming years," Sen. Dan Liljenquist, R-Bountiful.
He said that as Medicaid costs continue to grow at three times the rate of the economy, lawmakers can either raise taxes "substantially," "or lay off 10,000 school teachers in the next decade," neither of which is very likely.
"Doing nothing is not an option," Liljenquist said. "We either cut rates or move toward new ways of paying."
He hopes to request a federal waiver, allowing Utah to compensate Medicaid providers differently, preserving the private market and "making money by optimizing care," he said.
Nevertheless, lawmakers are working with advocates to find solutions and Hilman hopes the thoughtful collaboration will save Medicaid money and help the Utah Health Policy Project to gain credibility to ask for little things in return.
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