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Apr 18, 2011

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Yi  Li  You

Suggestions on Efficient use of Medicaid to reduce health care cost while keep necessary coverage for recipients:
Prepared by Yi LI You, LSW,E.D.
Chinese Social Service Center (CSSC)

Collecting Monthly Premiums:
Ask MA, GAMC recipients to follow what MN Care program is doing
• Pay premiums, such as $4.00 every month, based on their income.
• These premiums are affordable and can help to reduce some cost for the state.
• Cuts to any coverage benefits should be avoided.
• By asking recipient to pay some premium, it can raise responsibility and avoids the risk of recipients taking medical benefits for granted.

Limit MA reimbursement to Senior Adult Day Facilities to 3 days max per week for each senior attendant::
• The state should screen the existing Medicaid system, foster care and adult day care facilities to avoid abuse, and fraud of the Medicaid
• There are cases where clients wish to leave facility care but some facilities prevent clients from leaving due to loss of money from Medicaid.
• Audit quarterly how much the state (Medicaid) spent on each facilities. Limit each senior participant who attends senior adult day center max 3 days per week.

Medical Assistance designates health plans (insurance companies) to appropriate money to the facilities. It seems that health plans give money 3 or 6 months ahead of time to senior adult day centers once a client is approved, regardless of if the client actually shows up at the facility or not. Hence loop holes are created for these centers to get money from Medicaid, but not use on behalf of seniors.

M.A. pays $66 or more for each senior per day for attending a senior adult day center. If one senior attends a senior adult day center 5 days per week, M.A. will pay him/her $1320 per month and $15,840.00 per year. This money from M.A. is for recreation and entertainment only, not for their medical necessities as the purpose of senior adult day center is to reduce isolation and to increase their social interaction of seniors who usually stay at home alone.

If any senior attends 2 to 3 days per week at a senior adult day center, it will be enough to serve the purpose. In fact, there are examples of seniors who attend more than 3 days per week becoming exhausted and overweight or obese.

Many centers encourage seniors to ask for permission from case workers to come 5 days per week, so these centers can make profits from State. If Medicaid limits senior attendance to senior adult day care 2-3 days per week maximum, one senior will save $6,336.00 per year of the state’s Medicaid fund. With hundreds, perhaps thousands, of senior adult day centers in MN. How much money we can save for the state?

Resume Dental Coverage to before 2003 level:
For dental coverage for Medicaid, GAMC and MN Care recipients, I hope it can resume to what it was before 2003.

• Before 2003, all MN Care recipients can have free regular cleaning twice a year, same as Medicaid recipients.
o Previously, copays were affordable by recipients at 50% copay for restorative treatments, like deep cleaning, root canal treatment, etc.
• After 2003, MN Care recipients without children were cut off all dental coverage, including regular dental cleaning.
• Since 2008, dental coverage was recovered but all MN Care recipients, with and without children, can have all of the dental coverage without paying any copay, even for deep cleaning and root canal treatments. Hence, more budget deficit results.
• From Jan, 2010, state cut down dental care benefits even on Medicaid recipients:
o all Medicaid and MN Care recipients can only have regular dental cleaning once a year, instead of twice a year.
o Now, no one can have deep cleaning; and root canal treatments on back part of the mouth, unless they pay out of their pockets, which cost about $800 and $750 respectively.
o This has caused many recipients to have gum disease and unnecessary extractions.
o Many patients have tooth infection, which cannot get treated by root canal and have to be extracted.
o The use of dentures is more expensive than root canal treatments
I recommend resuming pre-2003 dental coverage as many recipients are waiting for the dental treatments desperately. I highly recommend including co-pays on treatments, 30 to 50% of the cost, to help reduce costs for the state.

Resume Medical Emergent Treatment for LPR under 65:
Many applicants who need medical treatments for serious conditions cannot get approved for EMA (Emergency Medical Assistance) if they are Legal Permanent Residents (LPR) and under 65
• Examples of medical conditions include diabetes, high blood pressure, any surgeries that need hospitalization
• The lack of EMA puts these clients’ health in dangerous conditions.
• For LPR under the age of 65, county workers keep sending them to SMERT evaluation for “disability review”, which does not make sense at all.
• These people have serious medical conditions, but are not necessarily disabled.
• They can do activities of daily living ADL’s independently but are in serious need of medical treatments to avoid more serious medical risks to their lives.
• “Disability Reviews” for these individuals are unnecessary and a poor use of state resources. It screen clients for eligibility for SSI but has nothing to do with “Emergency Medical Assistance.”

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