WASHINGTON — California's Medicaid program, Medi-Cal, ranks among the 10 best in the nation, according to a report released Monday by the Public Citizen Health Research Group, a public interest organization.
Nevertheless, the report--which named Minnesota the state with the best program and Mississippi the state with the worst--said there are deficiencies in virtually every program. Thus, California's high rating "demonstrates the overall mediocrity of state Medicaid programs more than it signals the state's excellence," the study said.
Specifically, the report said the various states do not fund their program equally, resulting in unequal access and coverage. It recommends more federal control and calls for 100% funding by the federal government.
Source of Frustration
"The hopes of the designers of Medicaid have been frustrated, and the old order is essentially unchanged," Dr. George Silver, a Yale University public health professor who served in the Department of Health, Education and Welfare at the time Medicaid was enacted, said. "The promise of equal access and equitable provision of medical care for the poor of this country continues to be denied."
The Medicaid program was created in 1965 to subsidize health care for the poor. The federal government and the states roughly split the cost, with the states having considerable latitude in setting eligibility requirements, the scope of services and reimbursement policies.
The report concluded that "as implemented today, Medicaid makes a mockery of President (Lyndon B.) Johnson's triumphant statement after its signing: 'Today we expect what yesterday we could not have envisioned--adequate medical care for every citizen.' "
The report charged that as a result of the great flexibility allowed the states, "tremendous inequities exist across the nation." At the state level, it said, "Medicaid fails because states vary widely in the breadth of their programs."
Further, the report said, a "highly statistically significant relationship" was found between the amount of money a state spent and the quality of its program. "High spending per poor person makes a better program," the study said.
The report recommended that the federal government establish uniform eligibility standards, services, quality control systems and reimbursement methods, and assume 100% of Medicaid funding, with the exception of administrative overhead.
California's program "has undergone much turmoil" in recent years, the report said, yet "the state has maintained reasonably liberal eligibility and service coverage policies."
The study added: "Five of our six Medicaid consultants agreed that California has one of the top 10 programs in the nation, and two named it among the states making the greatest progress."
Further, the report said, California "has initiated a variety of innovative programs," among them home- and community-based service projects. One such project, "On-Lok," "grew out of an existing community care program for the frail elderly in San Francisco's Chinatown," the report said.
"California works hard to ensure the quality of care provided to Medicaid patients," the report said, adding: "The state does more than most to encourage sound prescribing practices by excluding unsafe or ineffective drugs, and it has tough nursing home licensing standards and enforcement practices."