Medicaid Plan Prods Patients Toward Health

West Virginia has started a Medicaid plan that will provide penalties for unhealthy behaviors and incentives for health behaviors. (Free registration required. Go to bugmenot for a login if you do not wish to register.)

This is something that I’ve posted about before (here and here) and we’ll probably see more of this approach in the coming years.

Ignoring doctors’ orders may now start exacting a new price among West Virginia’s Medicaid recipients. Under a reorganized schedule of aid, the state, hoping for savings over time, plans to reward “responsible” patients with significant extra benefits or — as critics describe it — punish those who do not join weight-loss or antismoking programs, or who miss too many appointments, by denying important services.

…In a pilot phase starting in three rural counties over the next few months, many West Virginia Medicaid patients will be asked to sign a pledge “to do my best to stay healthy,” to attend “health improvement programs as directed,” to have routine checkups and screenings, to keep appointments, to take medicine as prescribed and to go to emergency rooms only for real emergencies.

“We always talk about Medicaid members’ rights, but rarely about their responsibilities,” said Nancy Atkins, state commissioner of medical services.

…Those signing and abiding by the agreement (or their children, who account for a majority of Medicaid patients here) will receive “enhanced benefits” including mental health counseling, long-term diabetes management and cardiac rehabilitation, and prescription drugs and home health visits as needed, as well as antismoking and antiobesity classes. Those who do not sign will get federally required basic services but be limited to four prescriptions a month, for example, and will not receive the other enhanced benefits.

…the new plan has stirred national debate about its fairness and medical ethics. A stinging editorial in The New England Journal of Medicine on Aug. 24 said it could punish patients for factors beyond their control, like lack of transportation; would penalize children for errors of their parents; would hold Medicaid patients to standards of compliance that are often not met by middle-class people; and would put doctors in untenable positions as enforcers.

“What if everyone at a major corporation were told they would lose benefits if they didn’t lose weight or drink less?” said a co-author of the editorial, Dr. Gene Bishop, a physician at Pennsylvania Hospital in Philadelphia.

Denying mental health aid to those who do not sign seems especially counterproductive, Dr. Bishop said in an interview.

“If you think about the people least able to do simple things like keep appointments and take all their medications,” she said, “people with mental health and substance abuse problems are right up there.”