Wednesday, March 20, 2019

Musings On Medicaid

It seems everybody has an opinion about Medicaid. Some people want to cut it, some people want to expand it, some people wish it didn’t exist at all.

In fact, right here in Colorado, our previous Governor even used taxpayer funds to rename and rebrand Medicaid in our State, as if that would somehow improve the program. Lipstick … pig … OK – let’s move on.

I understand why Medicaid draws so much interest and comment. It is a vital program serving people across our country with significant needs, and everyone wants to put their two cents in (figuratively, many people don’t want to put any money in to it in the literal sense).

However, for all the conversation and opinions around Medicaid, I find the opinions usually tend to ignore some basic facts about the program and its design. Medicaid was originally designed to be used as an insurance of sorts. Medicaid money was supposed to be used to “fix” a health issue in the short term.

However, the use of Medicaid has expanded over the years, and for one particular population that relies on those funds, fixes aren’t what are needed. I’m talking about people with intellectual and developmental disabilities (I/DD).

The Federal definition of a developmental disability states that it is “a severe, long term disability that can affect cognitive ability, physical functioning, or both.” The italics are mine, highlighted because a long term disability is one that isn’t likely to be fixed in a medical sense.

And yet, the majority of people who are classified as having a developmental disability receive their funding for services through Medicaid, which was created to fix things. Why Medicaid? Because it was the only pot of government money available to tap. Not because it was the right pot of money to tap.

Do you see the problem? Services in the I/DD field are funded using a “fix it” model. Therefore, many services are designed and delivered to try to fix what’s wrong. Again – this is because of the purpose of the available pot of money. But if a disability is lifelong, and therefore unlikely to be “fixed,” that approach is wrongheaded at best and wasteful and damaging at worst.

This is a system screaming for attention, and it gets it. But much of that attention is unfocused, because the root problem is never addressed, and rarely even acknowledged. The message in the scream is to build on what is working for an individual, not what is not working. Homogenizing everyone’s skillset to be the same is insane. We would all be quarterbacks!

I’m not arguing that Medicaid isn’t necessary. People need that support. I am arguing that we need to take a long, hard look at how that funding is used to serve people with I/DD, and to fix a system that tries to fix things that can’t be fixed.

I’m calling for a makeover. For some disruptive attention. Stop talking about the program simply in terms of cuts to funding; or additions to funding; or fancy new names; and instead redesign the archaic Medicaid pot of funds for the future. It’s a big job, and it won’t be easy, but it is very necessary.

Then again, what do I know?

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