Problems in Medicaid Managed Care

The blueprint of Medicaid Managed care is one that envisions a nation where every person would have ease access to healthcare at affordable rates. In its design, the program was meant to cover any imagined health problem. Through its implementation, there has, however, been multiple problems and challenges along the way. For some challenges, solutions have been designed, and the issues has been solved. Other challenges remain to be solved as yet. Patients have insufficient access to healthcare owing to the continuous increase in the costs of care ( Hinton, Rudowitz, Dietz, & Singer, 2019) . As a contingent approach, Medicaid managed care organizations have been introduced. The provision of continuity in care is also a key challenge facing the Medicaid program. In this regard, this paper delves into the various challenges facing the Medicaid managed care, possible solutions, and a way forward for better healthcare.

Controlling the costs of healthcare services has been a significant challenge. Unlike Medicare, which has substantial funding from the federal government, Medicaid has a state, and Federal government combined funding system. A huge chunk of state budgets is committed to Medicaid. Principally, Medicaid is designed to offer cover and care for low-income earners. During recessions, most people have reduced income; they, thus, enroll for the program more during these periods ( Hinton, Rudowitz, Dietz, & Singer, 2019) . Since the government’s income plummet during period of economic distress, states either resolve to reduce payment rates for doctors or reducing possible benefits from the covered person, both of which have a detrimental effect on the quality of care that is dissipated to the patient population,

A considerable number of Medicaid enrollees receive care from privately managed Healthcare facilities. Most of the private insurers claim to be more efficient and offer better cost predicting services. However, they have been accused of inflating the administrative costs in a bid to generate more revenue and boost profits. There has also been instances where doctors enrolled in their schemes are unavailable to offer services as described within their websites, they end up registering doctors who, in actual sense, are registered with many other insurers and are usually too busy to be available for everyone. As a result, the quality of care delivered drops.

Inaccessibility of doctors, dentists, and consultancy services has been another challenge facing the Medicaid program. Primary care is the backbone of Medicaid and those enrolled should be able to access primary care with ease. However, due to what is at times termed as low compensation rates for doctors and consultants, very few practitioners are available for those under this cover. The reduced presence of consultants in this continuum hampers continuity of care ( Hinton, Rudowitz, Dietz, & Singer, 2019) . Those on long term management are at times subjected to repeat procedures to clarify diagnoses or confirm conditions due to the distinctive levels between those that made the primary diagnosis and their new caretakers.

Increased burden as a result of the need for long-term care is also a notable challenge associated with the program. While the program is conventionally thought to be for low-income earners, middle-income earners with chronic illnesses have been increasing in its subscription base. Over half of patients in nursing homes for chronic conditions are covered by Medicaid. Most of the funds that would be channeled to increasing scope of the coverage end up being channeled into these long term management plans (Christopher et al., 2016) . Furthermore, the increased rates of lifestyle diseases such as diabetes and hypertension in the American population promises to burden the program more. These illnesses require lifelong medications and will thus be a recurrent expenditure for the scheme which will mean that most resources will have to be channeled to these specific illnesses. The long term effect of this is denial of funds to other noteworthy patients.

Communities in rural setups have very few health facilities. This has resulted in Medicaid being unable to reach these medically underserved communities. Very few facilities and organizations are able to set up structures and send staff to sparsely populated areas because the low patient volumes hardly translate into any meaningful business profits (Christopher et al., 2016) . This unfavorable business environment has a ripple effect, in that the organizations that would be providing these services and receiving payments end up being far and wide spaced from each other. It thus suffices that those residing there do not have access or have to travel long distances to benefit from the Medicaid program.

Enrolment into the program is tied to one’s income. On the surface, this is a positive thing in that low-income families are able to get tax subsidies and receive coverage. However, fluctuations in family income translate to the changes in the nature of cover provided. It then implies that at any one given time, if the family income fluctuates, it is possible to lose out on a benefit, which might be a needed solution to an ailment for the moment (Christopher et al., 2016) . Efforts are, however, being made to streamline the same and create a uniform and more stable enrolment criteria that fluctuate less often.

Organizing care and providing appropriate services within the Medicaid program is a challenge. This results from the tension to balance the more commonly needed services and provide an economy of scale with the less frequently sought services. It is easier and affordable to offset the cheaper and common needs within the contracts, while certain critical services used by lesser portions of the population are left in the Medicaid fee per service category. Those that fall unfortunately within this bracket end up not benefiting from what should be the source of cheap healthcare financing for them.

In a bid to increase the accessibility to care especially for those in underserved communities, certain measures could help. Unique compensation packages for those in the rural areas that compensate for the reduced patient traffic can be implemented. For a similar procedure, a doctor in a rural set up should receive a little more salary than a doctor in an urban setup. The reasoning behind this is to incentivize doctors to offer their services within rural areas without feeling like they are losing out on significant incomes. This also ensures equity and quality in the provision of healthcare services, where both the urban and rural residents have similar services rendered to them.

Tax exemptions and land subsidies can be provided for persons that intend to set up hospitals and health facilities in rural areas. Reducing the possible capital and running overheads can serve as a motivation to compensate for the reduced profits that result from setting facilities in areas that have low patient traffics (Christopher et al., 2016) . Governments should make strategic partnerships to encourage facilities to serve the local communities by reducing the cut throttle competition that disqualifies certain localities from receiving certain services.

Auditing and inspection of the various private players within the Medicaid ecosystem should be done often. The aim should be to ensure that public funds are used in the most rational way possible warranting maximum benefit to taxpayers. Insurance schemes that offer maximal value should not only be recognized but have more clients extended to them (Christopher et al., 2016) . This ensures that a culture of adopting best practices is embraced within the private healthcare organization spheres and a consciousness of the spirit of the program is never lost.

Lifestyle diseases, among them, cancer, continue to be a significant cause of the upsurge in expenditure incurred by the Medicaid program. To ease the burden from this single disease, the idea of a single disease financing plan should be considered. This could include setting up facilities that exclusively and freely take care of cancer patients. This will ensure that they do not have to seek services from standard facilities and their compensation will be used to run these facilities. This single disease strategy can also be employed for diabetes and hypertension to ensure that the single most expensive conditions on the program are sorted independently.

While there have been challenges, various solutions have been implemented and are producing admirable results. Managed care Organizations have been running in Medicaid in a bid to reduce the overhead administrative costs of health services. The MCOs manage multiple facilities, receive, and process payments from Medicaid as a unit. MCOs also set capitations for different conditions and services to be offered making it possible for the state to plan better using private sector data (Hinton, Rudowitz, Dietz, & Singer, 2019) . MCOs ensure that there is a single roll of doctors and charging system for all their staff. Overall there is reduced duplication of roles that happens when all facilities transact with the government as independent scattered parties.

Going through the problems facing Medicaid has given me a chance to reflect and appreciate the headache that health economists and management experts have to think through each day. I have come to appreciate the hidden dynamics that are involved in the provision of accessible healthcare for all. If I were in charge, I would be keen on ensuring that the private players have the friendliest environment for business by reducing their running costs. I would also tighten the inspection and evaluation of these private firms to ensure prudent use of all public funds.

Medicaid has come a long way since its establishment. We have been able to surmount challenges, and that victory in itself affirms our ability to surmount the current challenges, and offer the best care to the people of America.

References 

Christopher, A. S., McCormick, D., Woolhandler, S., Himmelstein, D. U., Bor, D. H., & Wilper, A. P. (2016). Access to Care and Chronic Disease Outcomes Among Medicaid-Insured Persons Versus the Uninsured.  American Journal of Public Health ,  106 (1), 63–69. https://doi.org/10.2105/ajph.2015.302925 

Hinton, E., Rudowitz, R., Dietz, M., & Singer, N. (2019, September 6). 10 Things to Know about Medicaid Managed Care. Retrieved November 16, 2019, from The Henry J. Kaiser Family Foundation website: https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-managed-care/