NACo Medicaid Task Force talks reform

By Rebecca Troutman
Director of Research and Public Technology

The NACo Medicaid Task Force met in Cook County, Ill., on June 30-July 1 to consider and amend its draft principles on Medicaid reform. NACo President Karen Miller convened the task force last year in response to a request by U.S. Department of Health and Human Services Secretary Tommy Thompson. Secretary Thompson invited NACo and its county members to put forward the county perspective on Medicaid reform as Congress and the White House consider reform proposals.

President Miller appointed NCACC Executive Director Ron Aycock to the task force in recognition of his leadership role with the NACo Indigent Healthcare Caucus. This caucus was an outgrowth of then NCACC President David Plyler’s state fiscal task force, which had conducted a national survey of state Medicaid requirements on counties. A NACo Medicaid Task Force work group, which includes NCACC Director of Research Rebecca Troutman, also convened.

Prior to the Cook County meeting, the work group framed a number of guiding principles on Medicaid reform for presentation to the task force at large. To provide a context for the national reform debate, work group members first proposed outlining counties’ unique role in the Medicaid program. Since counties serve as both health-care providers — often legally the providers of last resort — and health-care payers, county officials can provide a distinctive leadership role in the development of reform proposals.

At North Carolina’s behest, and with strong support by New York and Florida, one of the principles recommended by the work group and accepted by the task force emphasized that the county revenue structure, with its reliance on property taxes, is unsuitable to fund a required county share of Medicaid. Both North Carolina and New York require their counties to pay a portion of the non-federal share of all Medicaid services. Florida has sought to expand its counties’ financial participation in Medicaid. Because this “local share” is largely funded through property taxes, it adversely impact poorer counties, which generally have higher percentages of Medicaid clients but have lower property tax bases to support Medicaid’s escalating costs.

Another essential reform principle focuses on health outcomes and results. To date, reform proposals have sought to control costs through service or eligibility reductions. The New York State Association of Counties arranged a presentation to the task force by John W. Rodat, president of Signalhealth. Rodat relayed his data studies, which show that a better tracking mechanism and implementation of best practices in a contained health community improve overall health conditions more efficiently. North Carolina, through its Community Care networks, has begun experimenting with disease management programs in an effort to contain Medicaid costs while improving the client’s health status.

Task force members also highlighted the need for greater inter- and intra-state flexibility. Communities must be able to tailor their health programs to provide a more responsive and adaptive health insurance program for the indigent and medically needy. States should work with counties to maximize local health-care resources, such as county hospitals and health departments.

The task force concluded its agenda by instructing the work group to refine the reform principles for presentation to President Miller at the NACo Annual Conference on July 16-20 in Phoenix. Thereafter, NACo will share the county perspective on Medicaid reform with Secretary Thompson in preparation for Medicaid reform consideration.