Over the last several decades, most states across the country have shifted how they manage the health care of their low-income residents. Instead of coordinating directly with providers and paying for each medical procedure, states have, more and more, handed over that administrative responsibility to outside entities. The trend has not hit Maine until now. <\/p>\n
Art by George Danby <\/p>\n
A compromise bill proposed this week by Maine Republican Sens. Roger Katz of Augusta and Tom Saviello of Wilton would expand Medicaid coverage to 70,000 residents under the Affordable Care Act and start Maine on a years-long path of converting to a managed care system where the states Medicaid program, MaineCare, would be contracted out to private companies or nonprofits. <\/p>\n
By all accounts, it would be the largest change to hit MaineCare in years, possibly decades. The goal, Katz and Saviello said, is to ensure all Maine residents have access to quality health care within a system that is ready for them and able to deliver medical care in a cost-effective way. <\/p>\n
The status quo in MaineCare, even if we dont expand, is unacceptable, Katz said. <\/p>\n
Whether you have ever held a MaineCare card or not, switching to a managed care model would affect you. You might work in the health care or social assistance industry now, or you might in the future; employment in the field grew by 22.6 percent between 2000 and 2012. You might have an elderly parent facing a need for long-term care. Or perhaps you are a taxpayer; MaineCare will comprise about 23 percent of the state general fund in fiscal year 2014. <\/p>\n
Even if youre not familiar with the general term managed care, you probably already know what it is. <\/p>\n
The beginnings of managed care can be traced back to 1929, when a physician in Oklahoma established a health cooperative for farmers lacking a nearby hospital or medical specialists, according to the federal governments National Council on Disability. The physician, Michael Shadid, sold shares to create a hospital and then developed an annual fee schedule to pay for the cost of care. By 1934, he had 600 family memberships. <\/p>\n
This kind of prepaid health plan is what we would now call a health maintenance organization, or HMO: People regularly pay a fixed fee regardless of whether they require medical care, and a wide variety of medical services are available if they need them. They also have a primary care provider who can refer them to specialists. Procedures are covered if they see providers within a certain network. <\/p>\n
If you have an HMO or a preferred provider organization, a PPO, you have a managed care plan. <\/p>\n
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The rest is here:<\/p>\n
Medicine for Medicaid: Will Maine reform health care for low-income residents?<\/a><\/p>\n","protected":false},"excerpt":{"rendered":" Over the last several decades, most states across the country have shifted how they manage the health care of their low-income residents. Instead of coordinating directly with providers and paying for each medical procedure, states have, more and more, handed over that administrative responsibility to outside entities Continue reading