Why Medicaid reform and expansion matter

The Mat-Su Health Foundation is grateful for the Legislature’s efforts to move toward a more sustainable state budget. Our elected officials have combed through programs and services to see where they can reasonably trim with the least damage. We are grateful to them for adding back funds for the WWAMI medical program, some early learning programs, and frontline social workers. These programs impact the populations targeted in the health foundation focus areas: Healthy Aging, Healthy Minds and Healthy Foundations for Families.

One critical piece missing from the state budget is support of the federal authority to bring in $1.1 billion through Medicaid expansion, to backfill some of the cuts to programs that serve seniors, people with disabilities and at-risk populations. Medicaid expansion — and meaningful reform of how we administer Medicaid — will help achieve the Triple Aim of improved care, improved health and reduced per-capita costs for Alaskans.

The Mat-Su Health Foundation is at the apex of health reform. We believe it’s possible and we bring data, analysis and new perspectives to help achieve the Triple Aim in Mat-Su.

To this end, the foundation’s board supports:

• Expanding Medicaid to cover more Mat-Su (and Alaska) residents so they can access care in more cost-effective ways to lead more productive lives.

• Using Medicaid expansion dollars as a catalyst to reform Medicaid to control costs and make the program more sustainable.

• Designing Alaska’s Medicaid expansion as a path to self-sufficiency for individuals to ensure they enter or remain in the workforce.

• Building an “opt out” provision into state statute if the federal government reneges on its obligations.

Access to care in the appropriate setting improves health outcomes and controls costs. Hand in hand, reform and expansion can actually improve access to care. The health foundation recently published the first report of a Behavioral Health Environmental Scan on the Mat-Su’s Behavioral Health Crisis Response System. The report, which includes a “deep dive” on Mat-Su Regional Emergency Department visits in 2013, shows that reform measures could control health care expenditures for all payer groups, including Medicaid patients. Medicaid expansion could prevent costly emergency department visits by those without insurance coverage.

Of all Mat-Su Regional Emergency Department visits in 2013, 16 percent were made by “high utilizers” who bounced back to the emergency department five or more times in the same year. Fifty-six percent of all high utilizers were presented with behavioral health diagnoses. Sixteen percent of Mat-Su Regional emergency department’s high utilizers had no form of reimbursement to seek care upstream in lower cost settings. If a portion of these folks were covered by Medicaid through expansion, they could get access to care in lower cost settings. There are at least 2,150 Mat-Su residents who have some type of mental illness who would be eligible for Medicaid coverage if expanded.

Mat-Su Regional’s Emergency Department sees five times the number of people with behavioral health issues than our community mental health center. The Mat-Su population has nearly doubled from 50,000 people to 98,000 people since 2000, but Mat-Su’s community mental health center grants from the Department of Behavioral Health stayed flat. State funding mechanisms for this safety net population literally drove people to seek care in the emergency department instead of in lower cost settings. Instead of getting care in a timely way from our community mental health center, these folks delayed care until it was a crisis and presented to the emergency department. Because they couldn’t pay the bill for those emergency department services, the emergency department recouped those dollars by shifting costs to other payers and the public.

Medicaid expansion would improve access to care for these behavioral health issues and prevent costly emergency department visits. Medicaid expansion would reduce this cost shifting and help lower health care costs across the system. Paired with meaningful reform measures, Medicaid expansion can help Alaska progress toward the Triple Aim: better care for individuals, better health for populations and lower per capita costs. That’s a healthy vision for our state, and one that the state’s operating budget should include.

Elizabeth Ripley is Executive Director of the Mat-Su Health Foundation.