New York is cited as “something of a case study in all that is wrong with Medicaid,” but also as a state “in the vaguard” of Medicaid reform, in a new National Affairs article by Paul Howard, director of Manhattan Institute’s Center for Medical Progress.

In a long article that could serve as a primer on Medicaid’s shortcomings as they relate to the current healthcare policy picture, Howard explains how Obamacare will give governors throughout the country leverage to press the federal government for much-needed “fixes to Medicaid that will help their states avoid a looming fiscal catastrophe.”

While Medicaid was supposed to provide care for the poor, Howard writes, there is little relationship between spending and health outcomes for program’s beneficiaries. Indeed, there is evidence that Medicaid is “deeply regressive,” spending more in wealthier states that get a lower federal reimbursement, he notes.

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Today’s Albany Times Union gives front-page play to a story that has picked up surprisingly little sustained media attention since it was first reported two years ago: since 1990, New York State has ripped off the federal government for billions of dollars in overcharges of Medicaid reimbursements for the developmentally disabled — and the feds want their bucks back.

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In a battle going back 15 years, the federal Centers for Medicare and Medicaid Services (CMS) has pledged to reduce Medicaid reimbursements to New York for the state’s developmentally disabled centers by as much as 80 percent. Daily rates per patient at the facilities had jumped from just over $1,700 in 1999 to over $5,100 by 2011.

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Federal Medicaid reimbursements to New York State could be cut by $1 billion a year to make up for more than two decades of excessive claims that one congressman compared to “fraud.”

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Governor Andrew Cuomo is betting the house on Medicaid managed care ringing up estimated savings of $34 billion, to be split between New York and the federal government over the next five years.

That’s his springboard to submitting a waiver request to the Center for Medicaid and Medicare Services (CMS) in the next few months, asking the federal government to give back to New York $10 billion of its $17 billion share of the savings the Cuomo administration expects to result from curtailing growth and improving patient outcomes.  Who could disagree with those goals in principle?

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Governor Andrew Cuomo’s propensity for creating advisory committees, commissions and task forces — more than two dozen in all — is the subject of an article in today’s Wall Street Journal [subscription required].

Says Cuomo’s press spokesman:

“The commissions and advisory panels bring together unprecedented talent, experience and expertise in order to devise bold and consensus solutions to the most critical challenges facing the state and, under the governor’s leadership, it [sic] has been an unequivocal success.”

Well, at least he didn’t call it “historic.”

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Just-released November data indicate that Medicaid spending was within Governor Cuomo’s new cap through the first two-thirds of fiscal 2011-12 — but just barely.

The $15.3 billion cap on state-funded Medicaid spending within the Department of Health (DOH) was a hallmark of Cuomo’s budget control and reform for fiscal 2011-12. Future annual growth is supposed to be limited to the 4 percent average rate of medical cost inflation over the last 10 years.

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Trying to rein in runaway Medicaid spending is an historic annual event in New York. Governor Cuomo’s Medicaid Redesign Team was assigned the most recent task of both reducing spending and increasing the quality of care. The adoption of their initial recommendations in the 2011 Medicaid Budget claims to save $2.2 billion, growing to $3.3 billion in 2012. A major provision includes a new cap on annual state share Medicaid spending tied to average medical cost inflation of 4 percent.

Although the team’s final report was due Dec. 31, nothing had surfaced online or had been announced by the Cuomo administration as of mid-day today. Meanwhile, through October (seven months into the fiscal year), the Department of Health (DOH) reports steady progress in meeting savings targets, including staying below the new spending cap. But, it’s still not entirely clear whether savings will be fully achieved and if the Medicaid program will be better in the long run for both patients and taxpayers.

Loose ends (with page citations and links from the Redesign team’s work group reports and updates) include the following:

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Based on per-capita federal data, USA Today reports that “New Yorkers get more government aid per person from social programs than residents of any other state.”   The Empire State’s Medicaid spending per-person alone is more than double the average, but we’re also high in other categories of social assistance.

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Governor Cuomo says the state of Wisconsin is the model for his unusual collaborative approach to attempting to reduce Medicaid costs in New York — but a report in today’s Wall Street Journal (subscription required) cites “little evidence of savings” in the Wisconsin program.

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