Editor's note: Former Lt. Gov. Greg Bell is the president and CEO of the Utah Hospital Association.
Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), was in Utah Monday. Her visit coincided with CMS’s recent announcement that CMS had approved Utah’s unique waiver request to allow Medicaid benefits to be extended to about 5,000 people who are homeless and/or are addicts. Verma’s grant of Utah’s waiver request nicely dovetailed with two other major developments.
A few years ago, the Legislature passed the Justice Reinvestment Initiative, which reduced the classification of some drug-related crimes because much drug consumption and some drug-related criminal acts were born of addiction rather than the typical criminal intent. But without the resources to treat addicts, the changes to the criminal code didn’t mean much. Consequently, many addicts were arrested and went right out the back door of the jail because of overcrowding. It got to the point that police weren’t even arresting some offenders because there was no jail space. It was futile.
Meanwhile, in the Pioneer Park and Rio Grande area, criminal behavior and nuisances like sex acts, public defecation, urination, camping out in the median strip and landscaped areas along 500 West escalated to an intolerable level. After some murders and other violence, Speaker Greg Hughes and other state and local leaders said it was time to take the area back and formed Operation Rio Grande.
Operation Rio Grande’s first objective is to restore order and assure public safety among the homeless population and for the properties and businesses in the area where the homeless have typically congregated, especially around Pioneer Park and Rio Grande Avenue. The second objective is to assess the addicted and criminal individuals who frequent the area to see whether they should be prosecuted or entered into therapy. The stumbling block, however, was that there are not enough resources to treat the mentally ill and those needing substance abuse therapy.
Able-bodied adults earning under the federal poverty level have not been eligible for Medicaid until the Affordable Care Act allowed states to expand Medicaid to cover them. Although Utah’s Legislature chose not to extend Medicaid to all able-bodied adults, Rep. Jim Dunnigan (R-Taylorsville) passed a bill that instructed the state to apply for a waiver from CMS to extend Medicaid to homeless persons and non-functional drug addicts.
Enter Ms. Verma with the CMS waiver, which extends Medicaid coverage to this unfortunate population. Under the waiver, Medicaid will not only cover mental health services, but in a wonderful development, will allow recipients to receive substance abuse therapy and recovery as a covered benefit. Public and private providers like Odyssey House will consequently be adding new beds and treatment resources to handle the increased enrollment of those wishing to beat their addiction and return to productive lives.
It is estimated that the Dunnigan waiver will bring about $100 million of federal and state dollars annually to treat these problems. Hospitals will contribute 45 percent of the state’s share.
Seema Verma has worked in both the public and private sector. She gained national attention as the adviser to Governors Mitch Daniels and Mike Pence as they designed and implemented Healthy Indiana 2.0, a conservative version of Medicaid expansion.
Administrator Verma’s agency controls one-quarter of the federal budget, about a trillion dollars, which is spent mostly on Medicare (insurance for those 65 and older), Medicaid (insurance for low-income disabled, pregnant women, blind) and CHIP (insurance for needy children).
Ms. Verma is a different kind of “bureaucrat.” As I sat in meetings with her on Monday, I was surprised several times by her clear determination to break down the walls of government regulation (CMS issues 11,000 pages of regulations per year, she said), to make CMS rules sensible, to get out of the way of good medical practices, to make it simpler to deal with the federal government, to allow states much more latitude in administering their Medicaid programs to reflect their values and priorities.
Ms. Verma showed genuine concern for the beneficiaries of Medicaid. She didn’t want a dog and pony show or to meet only with dignitaries. She wanted to be sure that this expanded Medicaid program would help those for whom it was intended.