There is an interesting article in the Lowell Sun this week -- and other articles appearing everywhere quoting Congressperson Capuano -- claiming that Massachusetts got a bad deal from the Centers for Medicare and Medicaid Services (CMS), which screwed ("stiffed" in Lowell Sun terminology) Massachusetts out of billions of dollars in Medicaid money. I wish someone would do a little research before opining on this issue and answer a few simple questions.
- What is a Medicaid waiver?
- What is a Medicaid demonstration?
What is being waived are the rules other states have to follow to get reimbursed for half of the state's Medicaid spending (except that a bunch of the other states also get waivers, making Medicaid just another completely screwed up government program).
I believe it works something like this.
- Almost 20 years ago Massachusetts got a "Medicaid waiver" to use Medicaid money to help fund our "free care pool" to pay hospitals for services given people who are NOT eligible for Medicaid in the rest of the country (other money going into that free care pool comes from taxes Massachusetts residents pay on their healthcare insurance and hospital bills; if more money is needed it just comes out of our regular taxes and more money is taken away from state cops and state parks and local aid... or is borrowed in some backwards way).
- A few years later, as part of negotiations concerning renewal of this original "free care pool" waiver (and as part of what led up to the now effectively repealed RomneyCare), Massachusetts said it would rather use that Medicaid money to "demonstrate" that giving free or almost free insurance to people NOT eligible for Medicaid is better than giving them free care (in other words, take the Medicaid money being used for free care for people not eligible for Medicaid and pay insurance companies to insure people NOT eligible for Medicaid --- rather than pay hospitals directly)
- But -- not surprisingly -- that idea failed and for almost 10 years now the state and Federal government has been both
- using Medicaid money to give free or almost free insurance to tens of thousands of people NOT eligible for Medicaid in the rest of the country and
- also using Medicaid money to run a free care pool for hospital services for people NOT eligible for Medicaid in the rest of the country (some of whom do not even live in Massachusetts)
- Basically we have been spending the same Medicaid money twice on something for which Medicaid was never intended.
Like I said, I don't pretend to understand it completely. I am just reading the five or six documents that CMS sent the state each time it OK'd this temporary waiver over almost 20 years. I may be reading it wrong. But it appears that even the flaming lefties in the Obama administration have apparently decided that the Massachusetts "temporary Medicaid wavier demonstration" didn't work. Twenty years is really as long as one can claim temporary.