Online CPR Certification Blog

According to a report by the Wall Street Journal, the Bush administration sent a letter to the state Medicaid directors indicating that the managed care organizations could restrict and limit coverage offered for emergency services to Medicaid beneficiaries. If this decision went through, it could have consequently removed the restrictions established back in 1997 by the Balanced Budget Act, the rules issued in January 2001 by the Clinton Administration and those issued in June 2002 by the Bush administration.

Bush administration overturns an earlier decision

Under the laws enacted in 1997, states can now put a requirement for the beneficiaries to actually enroll to MCOs such as the HMOs. But MCOs laws puts a requirement for provision of emergency services during cases in which a ‘prudent layperson’ can consider seeking emergency services. Medicaid beneficiaries are also required by the law to enroll in MCOs so that they can be able to access the emergency services at the nearest provider immediately. According to Bush administration, this decision would have consequently allowed the states to put limitations on the coverage availed for emergency services as a way of facilitating appropriate use of health care services especially primary care and preventive care.

The original decision was strongly criticized by the Democratic and Republican senate aids. According to them, this would have significantly affected the ability of the Medicaid beneficiaries to easily access the ‘rapid care’ services in an emergency. Also, Senator Bob Graham was planning to ask the senate members to vote to have the decision overturned. According to a letter that the chair of Senate Finance Committee, Charles Grassley sent, he said that the administration decided to reverse the decision as a way of ending the dispute that resulted on the rather overblown issue. Many lawmakers from either party were really delighted by the reversal, including also groups advocating for improved health care as reported by the Post.

Nursing home provision

Administration officials meanwhile said that the president will be including a provision in the 2004 fiscal year budget proposal which was going to provide about $1.75 billion within a period of five years to assist people with disabilities to be transferred to home based or community care from nursing homes, which usually costs much less. According to the proposal, the care would provide states with $350 million in the first year from the federal government. This money would be used for covering the cost of the home based care and adult day care services as well as other services designed to help people with disabilities. States would in subsequent years receive an equal amount of funds also from the federal government. This would be used for providing these services under Medicaid.