WASHINGTON – A new study says Maryland’s Medicaid program had the fifth- fastest growth in the nation from June 1997 to December 1999, a gain that state officials hailed as evidence of their “aggressive steps” to reach out to the public.
But the report by the Kaiser Commission of Medicaid and the Uninsured, released Friday, is not so enthusiastic. It cautioned that a significant part of Maryland’s increase was due to the temporary reinstatement of former Medicaid enrollees who had been dropped by the state.
The report said that without those temporary reinstatements, the growth in Maryland’s Medicaid enrollment falls from the fifth-highest rate of 24.3 percent to around 12 percent.
But even that rate was still substantial, the report noted.
Debbie Chang, deputy secretary for health care financing at the Maryland Department of Health and Mental Hygiene, insisted the massive increase in Medicaid enrollees in the state is permanent. She said it has more to do with the booming enrollment in the state’s child health insurance program than the “temporary reinstatements” mentioned in the report.
“There are 76,000 children in our Medicaid program today,” she said. “These are new faces for the year. It is these children that account for the reported numbers.”
But Leighton Ku, a senior fellow in health policy at the Center on Budget and Policy Priorities, said that “Maryland stopped providing Medicaid to those who no longer were eligible for their welfare program,” when it separated the two programs in 1997 under federal order.
“That was illegal,” said Ku. “The federal order stated that those who were not eligible for welfare could still be eligible for Medicaid. But the state did not follow initially.”
Ku said that when the University of Maryland law school threatened to sue on behalf of the former Medicaid recipients, the state was forced to find those former recipients and reinstate them temporarily while their eligibility was evaluated.
It is those temporary recipients who drove up Maryland’s numbers, the report said.
Ned Wollman, the deputy director for beneficiary service administration at DHMH, conceded that the state “may” have lost eligible Medicaid recipients when the program was separated from welfare.
“Some people who were eligible may have been denied,” Wollman said. “But, we are in the process of incorporating those people back in the program. If we didn’t, it would have resulted in a lawsuit.”
The Kaiser study did credit Maryland for expanding the income-eligibility for children — one of 36 states to do so — while also taking steps to simplify the enrollment process. The report said Maryland has eliminated face-to-face interviews for Medicaid applicants and dropped the asset test, in which a family had to show it was poor enough to be eligible.
But the report said the state could do more. Maryland has not adopted other enrollment simplification methods like 12-month continuous eligibility and “presumptive eligibility,” which makes it easier for health care providers who serve low-income children to give temporary Medicaid cards.
Chang maintained that the state has adopted measures that are “superior” or “almost as good” as those.
“We have streamlined our application process by making it a three-page application. And those who apply need to do so only once,” she said. “In the case of presumptive eligibility, the recipient will have to file two forms — the temporary and the main one.”
Chang said that the state’s Medicaid program is simply better than it was before, when it was linked to welfare.
“The Medicaid system in the state today is just a superior version of what we had then,” she said. “We did have a separate Medicaid system at the time of the order. . .The system used today is just an improved version and the results of that are evident in the study.”