Lawmakers seek cure for Medicaid

April 22--State lawmakers will tackle the soaring cost of the Massachusetts Medicaid program when budget debates begin in the House on Monday, and Republicans hope to push through their own proposals they say will restore the program to what it was originally intended.

"It's just an unsustainable model," said state Rep. Jim Lyons. "Originally the primary goal was to provide health care to the poor and to the disabled. We're seeing it develop into a health plan for everyone."

Enrollment in MassHealth -- the state's Medicaid program -- has skyrocketed from 1.3 million to 1.9 million people over the past six years.

Spending on MassHealth is expected to surge by $322 million next fiscal year alone, accounting for 41 percent of the state's proposed $40.3 billion budget.

Part of the huge increase can be attributed to federal implementation of Obamacare that allows full- or part-time employees of a certain income level to bypass their work-offered insurance and still sign up for MassHealth.

The state estimates that amounts to about 379,000 people.

Gov. Charlie Baker has proposed a plan to hit some businesses with a $2,000-per-employee penalty if their health insurance plans don't meet certain criteria.

But the House has its own plan, which would still assess a fee on businesses, but allow state officials more freedom to craft the details.

Lyons told the Herald the state needs to fix the inner-workings of MassHealth first.

"Before we start charging the taxpayers and charging businesses, we ought to know exactly who's on the program," the Andover rep said. "That's what we're trying to do. ... We're hoping that the Legislature has a conversation about this overall cost and that whatever we decide to do, we do it with concrete numbers, so we know who's receiving the benefits."

Lyons and state Rep. Marc Lombardo will offer a series of amendments on the House floor as part of budget discussions aimed, Lyons said, at returning MassHealth to a program geared primarily toward helping the poor and disabled.

Among them, their proposal would prevent Bay Staters who are offered subsidized insurance at work to sign up for any state-funded health care plan, such as MassHealth.

Another amendment would allow MassHealth to charge an average premium of $2,000 for enrollees over the federal poverty line.

Spending on MassHealth could not exceed 30 percent of the overall state budget, and a fiscal control board would be created to oversee MassHealth for the next five years and perform an audit of enrollees and fees charged by providers.

Lyons and Lombardo are planning to hold a press conference Monday morning at the State House to detail their proposal and try to create momentum for it.

Lyons also wants to learn more about how much taxpayers are shelling out to cover illegal immigrants under MassHealth.

He pointed to a Gov. Deval Patrick-era memo from then-Health and Human Services Secretary JudyAnn Bigby in 2011 claiming that 4 percent of the 1.3 million enrollees of MassHealth that year were "immigrants who have not provided documentation of qualified status." That amounted to 54,732 people at a cost of $93 million, though only 1 percent of total MassHealth expenditures that year.

A MassHealth official told the Herald that illegal immigrants are only covered for emergency services, not provided with year-round plans that would include services like preventative care.

Those emergency services, called MassHealth Limited, cost far less than the average $8,500 average annual cost of a MassHealth member. It runs at about $960 per member per year, or $480 after the state receives federal reimbursement.

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