New HHS secretary challenges states to cut Medicaid "waste"

Nursing Homes, March, 2005 by Douglas J. Edwards

Medicaid loopholes and accounting gimmicks that have increased funding for nursing homes in some states might be in jeopardy under the second Bush administration. Although new Health and Human Services Secretary Mike Leavitt told the World Health Care Congress (as reported by the Associated Press) that he sympathizes with state officials facing budget pressures and understands their plight (himself the former governor of Utah), he added that "[t]his isn't about blame; it's a simple statement that it has to stop." Referring to the ways states manipulate Medicaid rules to boost federal contributions, Leavitt said, "It's a shell game that makes no one healthier."

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Long-term care might have at least one "in" with the new secretary. Sara V. Sinclair, chair-elect of the American College of Health Care Administrators, worked under Leavitt when he was Utah's governor; she headed the Utah Department of Health's Division of Health Systems Improvement from 1993 to 1997. She says long-term care "wasn't his main focus, but he considered it very important, and he tried to address it through good people."

"Mike Leavitt pushed the edges in what he expected from the health department administration," adds Galen Ewer, administrator/CEO of seniors care provider CHRISTUS Health Utah. Ewer notes that Leavitt implemented a FlexCare program that redirects people of all ages from nursing homes to the least restrictive environment. Two notable features of this, Ewer says, "was the concern to cover all ages and, second, it did not save the state money compared with the cost of a nursing home stay." Ewer notes that the current focus is on ensuring the least restrictive environment, not saving money.

BY DOUGLAS J. EDWARDS, ASSISTANT EDITOR