State rule change
saves $5.8 million
in hospital costsMedicaid patients may
now arrange care at
or near their home
The state has saved $5.8 million since mid-June with a "going home project" allowing hospitalized Medicaid patients to transfer benefits to a less costly home or community-based care, according to Gov. Linda Lingle.
Lingle said 200 people have left hospitals since a policy change by the state Department of Human Services gave them the choice to shift their Medicaid payments.
The change improves the quality of the patients' lives, while saving the state an average of $28,800 per patient each year in hospital costs, she said.
State Human Services Director Lillian Koller, whose department administers the Med-QUEST Division, said many Medicaid recipients have been stuck in hospital beds needed for emergency care because of a shortage of nursing-home beds.
About 600 to 800 Medicaid patients were in hospitals waiting for home- and community-based care before 200 transferred their benefits under the new policy, she said.
"They can take the money wherever they can get care," Koller said. "It's going to make a tremendous difference and this is just the beginning."
Another Med-QUEST policy that was changed prevented companies on Oahu from providing case management and other long-term care services on the neighbor islands unless they had offices there, Koller said.
She said the policy was based on the feeling that companies could not afford to fly workers back and forth -- a decision she thought should be left to the companies.
"It was one of those obvious common-sense ways to break through unnecessary obstacles, unnecessary barriers to people getting care they need on the neighbor islands," Koller said.
Koller said Maui has a shortage of foster homes to take discharged patients but they gradually are moving out of Maui Memorial Hospital.
Allowing a patient to take Medicaid reimbursement out of the hospital into a home or community setting also "is signaling the small business community that there is some business there if you want to develop it," she said.
The state typically pays an average of $2,500 to $3,000 a month for a Medicaid patient in a home or community facility, compared with $8,000 to $10,000 for a patient in the hospital, Koller said.
The state is also seeking to increase the classes of preferred prescription drugs for Medicaid clients from six to as many as 50, Lingle said, explaining this will save about $8 million the first year in discounts from drug manufacturers.
Physicians in about 50 specialties have been invited to meet with Koller and state Health Director Dr. Chiyome Fukino to identify the most effective drugs for a preferred list for Medicaid patients.
Koller said they will look at all research about drugs in a class and decide on a list they prefer doctors to use. Drug manufacturers will provide a rebate in exchange for the free advertising and market share, she said.
Koller said they expect to kick off the list in December with 11 classes of drugs for Medicaid's 37,000 fee-for-service clients and eventually expand to the state's 142,000 QUEST recipients.
