Taking Medicaid local: Oregon dives in to the “experiment”

April 17, 2013

Okay Network faithful, this article in the New York Times is a must read. Why? Well, for those of you who have been involved in developing a system of care framework in your community, it is right in your wheelhouse. Nothing speaks more to a system of care approach than does the “Medicaid experiment” currently underway in Oregon. Consider this excerpt from the Times article:

  • From the article…
    Mr. Kitzhaber, in an interview in his office at the Capitol, said the anecdotal interventionist health care story he imagines is that of a poor 92-year-old woman who develops congestive heart failure in a heat wave because she has no air-conditioner…

    “Under the current system, Medicaid will pay for an ambulance and $50,000 in the hospital,” he said. “What it won’t pay for is a $200 window air-conditioner, which is all she needs to stay in her home and out of the acute medical system.”

    Getting to that $200 decision, though, is not easy. It means both having a community health care worker able to check in on the woman, he said, then having a system flexible enough to send someone down to the local Target store with a credit card.

    It also requires a paper trail of measurements and procedures, officials said, to ensure that local decisions are fair and based on predictable outcomes, so that something like the purchase of one air-conditioner does not open the door to questions of bias, or claims that every poor family is entitled, in the name of fairness or social equity, to cooler air at state expense. 

It’s getting to that $200.00 for the air conditioner that is one of the critical keys to success for the Affordable Care Act. And that is going to take work at the local level to send a strong message to those making policy decisions that this approach is the way to go.

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