Minutes: Selection Joint Commission on Medicaid Oversight

Press Release

MEETING MINUTES

Meeting Date: August 10, 2006
Meeting Time: 1:30 P.M.
Meeting Place: State House, 200 W. Washington St.,
Senate Chambers
Meeting City: Indianapolis, Indiana
Meeting Number: 1
Members Present: Rep. Timothy Brown, Chairperson; Rep. Mary Kay Budak; Rep. Suzanne Crouch; Rep. Charlie Brown; Rep. William Crawford; Rep.
Peggy Welch; Sen. Patricia Miller; Sen. Robert Meeks; Sen. Gary
Dillon; Sen. Connie Sipes; Sen. Billie Breaux; Sen. Vi Simpson.
Members Absent: None.

Rep. Tim Brown, Chair, called the first meeting of the Select Joint Commission on Medicaid Oversight to order at approximately 1:35 p.m.

Rep. David Orentlicher Presentation

After the introduction of Commission members, Rep. Brown called upon Rep. David Orentlicher for a presentation entitled "Expanding the Pool: A Proposal to Increase Health Insurance Coverage in Indiana". (See Exhibit 1 for a copy of Rep. Orentlicher's slide presentation.)

Rep. Orentlicher explained how he had examined coverage expansion models from other states and the federal government and briefly described the plans (TennCare, Oregon, and Veterans Health Administration). Rep. Orentlicher described TennCare as being designed and implemented very quickly with all
Medicaid recipients plus persons up to 200% of the federal poverty level (FPL) to be enrolled in a managed care plan. The plan had a comprehensive set of benefits, including prescription drugs, with no caps on benefits, and with co-payments only for the expansion population. While access to care initially improved (8.9% of the Tennessee population was uninsured in 1993, improving to 5.9% in 1997), Rep. Orentlicher stated that the uninsured rate increased to 9.8% again by 2005.

Rep. Orentlicher also described the Oregon Health Plan, which was initially Medicaid reform legislation but was expanded to provide access to care for persons with incomes up to 100% of FPL with some restriction in benefits. The plan involved rationing according to a priority list developed by the Oregon Health Services Commission. Once the legislature determined the total budget, the set of covered and uncovered services was determined by an independent actuary. Enrollment increased by 39%, while costs increased by 36%. While initially improving coverage, Rep. Orentlicher stated that in 2005, Oregon's uninsured rate was back to where it was before the plan was implemented.

Rep. Orentlicher described the Veterans Health Administration (VHA) as a model for reengineering health care delivery. He described the plan budget as being flat between 1995 and 2000, while the number of patients increased by 40%. He said this was possible by:
• Defining practice standards that have been shown to result in better patient outcomes.
• Monitoring performance and measuring outcomes.
• Rewarding good performance and managing underperformance.
• Optimizing the use of technology.
• Promoting patient safety initiatives to reduce medical errors.

Rep. Orentlicher added that the plan has resulted in:
• A shift from hospital-based care to out-patient care.
• A decrease in staffing of 11%.
• A significant elimination of VHA forms.
• Savings in the pharmacy benefits management program.

Rep. Orentlicher also described HB 1352 (2006) which he introduced in the 2006 legislative session. HB 1352 would establish a pilot program for Medicaid recipients in Marion County to receive Medicaid services at Wishard Hospital. He described the pilot program as being a program of health care modeled after the VA's quality improvement initiative and which would include payment incentives for health care providers, among other provisions.

Rep. Orentlicher described his proposal for 2007 as including the pilot program from HB 1352 (2006) along with a pilot program providing for a buy-in for small businesses.

Source