State falls short on Medicaid reimbursements

With the 2016 legislative session beginning Monday, the spotlight shines brightly on K-12 education.

Since August, the state has blithely paid a daily $100,000 fine for failing to fulfill its court-ordered mandate to do right by our kids, despite the Washington Supreme Court’s pointed suggestion of a special session.

Governor Jay Inslee’s proposed supplemental budget may not abate the Court’s ire, although his suggestion to close four tax loopholes to increase beginning teacher salaries is a modest step forward.

In the shadows will be social services, where there are issues of interest.

The governor would invest significant new state resources in mental health care – $47 million altogether – particularly in a Western State Hospital quickly exhausting the patience of both the federal courts and federal government. Steps such as hiring 51 new registered nurses, and providing raises and bonuses to psychiatrists and psychiatric staff, can only help.

Ending decades-long discrimination, a federal regulatory declaration of rights for in-home care providers carries a $53.4 million state price tag, as such workers are no longer exempt from overtime. However, this will also draw $84.3 million in federal matching funds that these low-wage workers will spend and put back into the state economy.

More worrisome, the proposed budget overview notes, “The state will need about $180 million to cover rising Medicaid caseloads and health care costs.” As the state will be on the hook, come 2017, for a share of Medicaid expansion costs under the Affordable Care Act (ACA) – eventually up to 10 percent – it’s troubling it can’t meet current bills when the federal government is paying all expansion costs.

After all, with the unmet K-12 obligation looming, where do we go from here on Medicaid? Although pediatric dental care is one of 10 fundamental ACA obligations, the most recent study by the Health Policy Institute of the American Dental Association shows, again, that states most supportive of the ACA are among the worst Medicaid payers.

Washington Medicaid dental reimbursement for kids, as a percentage of private charges, falls, at 41 percent, far short of the 49 percent national average. Even Alabama, at 54 percent, pays more.

Low reimbursement rates will not attract dentists to serve the Medicaid population. In Washington, only 29 percent of dentists serve children on Medicaid, compared to a national average of 42 percent. Thus, expansion only creates a greater pool of young patients to turn away.

Similarly, the Kaiser Family Foundation ranks Washington 34th in relation between its state primary care Medicaid rates and higher federal Medicare rates. Even Mississippi eclipses Washington by paying primary care Medicaid rates at 90 percent of the Medicare rate, while Washington pays 66 percent. Here, both parties have rebelled against continuing, at state expense, an all-too-modest federal boost in Medicaid payment intended to support primary care. Accordingly, many providers like mine, who would gladly support a single-payer “Medicare for All,” reject Medicaid.

Medicaid for our most vulnerable, medically indigent residents cannot be an illusory care promise. But can it ever be anything more in a state, with a paramount K-12 obligation, that is allergic to both political courage and the tax reform courage might bring?

This story was originally published January 8, 2016 at 9:13 AM with the headline "State falls short on Medicaid reimbursements."