The state allocates nearly $1 billion for Medicaid. With the potential cuts proposed by the Federal Government, we must prepare for the possibility of these subsidies being reduced or eliminated.

I have examined various expenditures within the state budget and identified opportunities to significantly cut costs through one-time investments in different types of machinery. Additionally, thanks to advancements in technology, 60-70% of surgeries can now be conducted at Ambulatory Surgical Centers instead of costly hospitals. 

I also propose enhancing Federally Qualified Health Centers (FQHCs) by making one-time investments in equipment, enabling patients to receive their tests in-house rather than at external facilities, which can drive up costs.

Medicaid Cost Reduction Strategies

• Chronic Disease Management: Invest in community health programs for early intervention in conditions like diabetes, hypertension, and asthma to lower long-term treatment costs.

• Incentives for Wellness: Provide incentives, such as reduced co-pays, for Medicaid recipients who complete annual check-ups, vaccinations, and screenings.

• School-Based Clinics: Expand  access to healthcare for children through clinics in schools, reducing costly ER visits.

Improve  Managed Care Efficiency (Centennial Care Enhancements)

• Capitated Payment Models: Shift to per-member-per-month payments for cost predictability.

• Care  Coordination: Enhance teamwork among primary care doctors, specialists, and social workers to avoid unnecessary tests and  hospitalizations.

• Accountability Measures: Require Medicaid managed care organizations (MCOs) to meet quality and cost benchmarks.

Expand Telehealth Services

• Rural  Access: Increase telehealth reimbursements in rural areas to cut travel costs and treatment delays.

• Mental Health & Substance Use Treatment: Expand virtual counseling to reduce inpatient psychiatric costs.

• Remote  Monitoring: Use telemedicine for monitoring chronic diseases to allow early intervention and reduce hospital admissions.

Reduce Emergency RM (ER) Overuse

• 24/7  Nurse Hotlines: Expand nurse advice lines to help patients find appropriate care settings.

• Primary Care Expansion: Offer extended clinic hours and same-day appointments  to prevent non-urgent ER visits.

• High-Utilizer Case Management: Identify frequent ER users and assign case managers  to guide them to primary care.

Lower Prescription Drug Costs

• Bulk  Purchasing: Join or expand multi-state purchasing pools for prescription drugs.

• Generic  & Biosimilar Incentives: Negotiate better deals to increase the use of generic medications.

• Drug  Rebates & Transparency: Strengthen rebate programs and improve transparency in pharmacy benefit manager contracts.

Integrate Behavioral Health & Social Services

• Housing  Assistance for High-Cost Patients: Provide stable housing to reduce hospital visits for homeless Medicaid recipients.

• Food  & Nutrition Support: Expand food programs to prevent  malnutrition-related hospitalizations.

• Behavioral  Health Parity: Fully integrate mental health and substance use disorder treatments into primary care.

Reduce Fraud, Waste, & Abuse

• Advanced  Data Analytics: Use AI to detect improper billing patterns.

• Tighten  Eligibility Verification: Improve enrollment oversight to ensure only eligible individuals receive benefits.

• Audit Providers: Conduct routine audits to prevent unnecessary procedures  and billing errors

Transition to Alternative Payment Models

• Accountable  Care Organizations (ACOs): Create networks that share savings when costs are lowered without sacrificing quality.

• Bundled  Payments: Pay for entire treatment episodes instead of per service to  avoid unnecessary treatments.

• Value-Based  Payments: Tie payments to health outcomes instead of service volume.

Expand Home and Community-Based Services (HCBS)

• Reduce Nursing Home Dependence: Increase funding for home care aides to help  elderly and disabled individuals stay at home.

• Family Caregiver Support: Offer respite care or stipends for family caregivers to lower professional care costs.

• In-Home Monitoring: Provide remote health monitoring for elderly Medicaid  patients to prevent hospitalizations.

Maximize Federal and Private Partnerships

• Medicaid  Waivers: Apply for 1115 waivers to test cost-saving measures like  work requirements or health savings accounts.

• Public-Private  Health Initiatives: Collaborate with private health foundations and  hospitals to fund preventive care programs.

• Leverage Federal Grants: Seek additional funding for rural healthcare and telehealth expansion.
  

Key Themes in Successful Medicaid Reduction Models

1. Managed Care & ACOs: Shift from fee-for-service to value-based care (e.g., Oregon, Massachusetts, Tennessee).

2. Care Coordination: Implement regional teams to support high-risk patients  (e.g., Minnesota, Vermont).

3. Preventive & Primary Care Investment: Enhance community health teams and  incentivize wellness visits (e.g., North Carolina, Indiana).

4. Prescription  Drug Cost Control: Utilize bulk purchasing and negotiate drug prices (e.g., Massachusetts, North Carolina).

5. Fraud  & Waste Reduction: Strengthen eligibility criteria and apply data analytics to detect fraud (e.g., Tennessee, Colorado).

6. Home & Community-Based Services (HCBS): Decrease reliance on costly institutional care (e.g., Rhode Island, Tennessee).