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Feb 1, 2008 9:09 pm US/Eastern
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Md. Lawmakers Alarmed At Federal Medicaid Changes
ANNAPOLIS, Md. (AP) ―
Maryland could lose up to $75 million in federal money for Medicaid case management services designed to provide preventive health care, a change that could affect up to 200,000 state residents, state health officials and advocates said Friday.
The rules, which were drafted by the federal government's Centers for Medicare and Medicaid Services and will affect all 50 states, are scheduled to take effect in March.
The rules were made in an effort to save money by reducing abuses in the system.
John Folkemer, deputy state health secretary for Maryland, described the CMS rules as very far-reaching during a briefing to the Maryland House Health and Government Operations Committee.
He said every case management program in the state will be affected.
"Every single thing we're doing in case management has to change, and some of them have to change significantly," Folkemer said.
Dennis Smith, director for the federal government's Center for Medicaid and State Operations, said the rules are needed, because Medicaid money is being used to fill budget holes in county and state budgets unrelated to health.
Too often, Medicaid money has been used to pay for things like juvenile justice, parole services and other things that are not directly related to health, Smith said.
"Good case management leads to better outcomes for the individual and better savings for the taxpayer in the long run," Smith said. "That's what our rule is really about."
Folkemer said he didn't believe states that have been following the rules should be penalized for the actions of other states that may be abusing the system.
Critics also have said the rules were only just published in December, before the holiday season, and are moving swiftly toward taking effect.
But Smith said the federal government has been working with the states for more than two years.
"The rule is very consistent to what we have said all along: we want accountability. We want high quality," Smith said.
Sens. Barbara Mikulski and Benjamin Cardin, both Democrats from Maryland, have proposed a moratorium on the rules until next year.
Michelle Hart, a Baltimore County mother of three -- two of whom have disabilities -- said she has serious concerns about how the regulations will affect Maryland's Infants and Toddlers Program, which one of her children uses.
"What I've been left to do is actually contact my senators ... and keep my fingers crossed and not hold my breath too much," Hart told the committee.
Gov. Martin O'Malley has written to U.S. Department of Health and Human Services Secretary Michael Leavitt, urging him to reconsider the regulations, saying the quality of case management will likely be lowered.
"To come into compliance with the provisions of the rule, Maryland may be forced to leave many vulnerable populations without any access to needed case management services, or create disruptions and confusion in how they receive them," O'Malley wrote.
Maryland spends a total of about $150 million on case management services, with about half of the money coming from the federal government.
The new rules will end up shifting more costs onto states that decide to keep their programs intact, Folkemer said.
The rules will affect services designed to provide preventive care, such as transporting people with disabilities to and from doctor's appointments.
Kathleen Westcoat, president of Baltimore HealthCare Access, said the changes also could cause as many as 1,500 local health care providers to lose their jobs across the state.
"This legally suspect, dangerous final rule will hurt 200,000 people across the state," she said. "It will hurt about 80,000 in Baltimore city, and I really think the legality of this regulation must be reviewed and questioned."
Folkemer said the new rules narrow the definition of who qualifies for case management help.
The rules will force Maryland to either shut down programs are make big changes to how they are run.
Comments on the policy changes are due on Monday, and Maryland already has submitted comments, but Folkemer said he believed it would take legislation to prevent the rules from taking effect.
"They think that states are somehow manipulating the system as it is now and this is what they're committed to doing," Folkemer said of the CMS rules. "So I think really the only hope is that Congress will take some kind of action."
(© 2008 The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed.)