Greater range of Medicaid finance options wins support
■ The AMA also adopts policies to give patients more rights if they are enrolled in state health programs automatically.
By Charles Fiegl — Posted July 2, 2012
Chicago Low-income individuals would have more health coverage alternatives under a revised policy on Medicaid and state health plan financing adopted by the American Medical Association House of Delegates at its Annual Meeting.
Delegates debated a Council on Medical Service report recommending that states have the option either to maintain current Medicaid programs or to transition low-income patients who are nonelderly and nondisabled to a system of tax credits that would be used to purchase private health coverage. The credits would need to be equivalent to the cost of coverage and involve little or no patient cost-sharing, the report stated.
Some delegates praised the council for its report and recommendations because of the fiscal challenges facing state governments. But several raised concerns about potential adverse impacts to patients and urged the AMA to adopt several safeguards.
Patients qualifying for state health programs do not always have coverage when they seek treatment, said Richard Pan, MD, an alternate delegate for the American Academy of Pediatrics from Sacramento, Calif. He successfully advocated for retaining AMA policy on presumptive assessment of eligibility and retroactive coverage. Delegates also agreed to support the development of safety-net mechanisms that would backdate coverage for eligible patients to the time when they sought care.
The council report also contained new language that backed limiting patient churning in insurance programs by adopting 12-month continuous eligibility across Medicaid, the Children’s Health Insurance Program and upcoming health insurance exchange plans. But the delegation had been split on whether to support auto-enrollment structures that move certain patients who don’t sign up on their own into programs without first obtaining their consent.
When Massachusetts adopted its 2006 health system reforms, it included an auto-enrollment policy, said Thomas E. Sullivan, MD, chair of the Council on Medical Service and a cardiologist from Beverly, Mass. “Auto enrollment worked reasonably well. It doesn’t mean to say it’s perfect. None of these things are perfect.”
Delegates agreed to an AAP amendment that gives patients the right to switch health plans within 90 days of an auto enrollment.
In a separate resolution, delegates resolved to have the AMA advocate to the Centers for Medicare & Medicaid Services against automatically enrolling individuals eligible for Medicare and Medicaid programs into dual-eligible demonstration projects.