Medicaid officials hope to implement several cost-saving policies in the next two years.
One change will be a shift in emphasis to managed health care. The Division of Health Care Financing, which administers Medicaid, hopes to increase contracts with health maintenance organizations.A major cost to the program has been unnecessary and expensive emergency room charges, said Rod Betit, Health Care Financing director. The division hopes to put controls on emergency room usage. Non-emergencies would not be handled in the emergency room, saving thousands of dollars a year.
Medicaid also wants to contract for vision services, laboratory work and contraceptives.
Several programs will be capitated once the division receives approval from the federal government. In a capitated program, Betit explained, bids are taken on a cost-per-patient basis. If the bids come in too high, the division will maintain the current fee-for-service program.
Capitated programs are planned for mental health, pharmacy and dental services.
"A capitated mental health program opens up ways for treatment to occur," Betit said, adding they not only save money but provide a broader range of options to the provider and client.
Joe Duke-Rosatti, Community Action Program, expressed concern that changing providers would have a negative effect - particularly in mental health programs. It would mean, he said, that someone who might have established a good relationship with a therapist or doctor would have to sever that relationship.
The division would also like to establish a flat-rate contract with nursing homes that would include ancillary services like those provided by a physician or pharmacy and would allow competitive contracting.
The suggestions were first adopted by the Medical Care Advisory Committee, composed of officials, physicians, consumers and advocates, which helps Utah's low-income medical care programs formulate policy.