Medicaid program needs legislative attention
John Gardner can sum up the state welfare program's upcoming legislative agenda in one word: Medicaid.
"Medicaid is a disaster in Montana and for every state. It's a train wreck everywhere," said Gardner, director of the Flathead County Office of Public Assistance.
Medicaid uses state and federal government money to help pay for necessary medical services for needy and low-income people. In Flathead County, about 5,000 people rely on Medicaid assistance - and the number keeps going up, Gardner said.
He cited several reasons for the increase in Medicaid needs - fewer jobs include health-care benefits, more federal and state programs are covering the needs of low-income children, health-care costs are rising and the population is aging.
It costs Montana about $2,200 per year for each Medicaid-eligible child, while each adult Medicaid enrollee costs the state nearly $7,000 annually.
The bottom line, Gardner said, is federal mandates without the money to match.
Under broad federal guidelines, each state establishes its own standards for Medicaid eligibility, benefits packages and provider payment rates, but states must meet certain minimum standards and benefits.
"It's a Catch 22 for states," Gardner said. "They can't afford Medicaid, but in Mississippi, when they tried to cut benefits, they ended up in court over it."
Gardner sees a single-payer system of health care as the most logical fix for spiraling Medicaid costs that are bleeding states dry.
Under a single-payer system, everyone is covered under a publicly run health-insurance program under which the government or some other single entity serves as the sole source of payment for a broad range of health-care services.
"There's no Western civilized country [except the United States] that doesn't have some form of socialized health-care services," Gardner said.
Dental care is a good example of how low-income people are affected because very few dentists accept Medicaid, he continued.
"If you need a botox injection, America is a great place to be. If you need an abscessed tooth pulled, it's a terrible place to be," Gardner said.
A recent bright spot in Montana's welfare arena was Gov. Judy Martz's decision to restore $30 of the average $132 cut her administration made to monthly cash welfare benefits in August 2003.
The bump up in benefits begins Jan. 1.
Montana gets $42 million a year from the federal government to manage its welfare program, but when block grants were cut back 18 months ago, the state chopped the Temporary Assistance for Needy Families program by 26 percent.
A declining case load for cash assistance, statewide and in Flathead County, is now creating a surplus, but extra money will be funneled into low-income energy assistance and child-care programs locally, Gardner said.
About 200 Flathead County families make use of the welfare cash-assistance program. Fewer needy families are opting for cash assistance because the participation requirements have increased, Gardner said. There's more leg work needed to satisfy the job-searching requirements.
And in Flathead County, the economy is good and jobs are plentiful, he added.
Caseloads statewide for families needing cash welfare assistance decreased substantially during the first phase of welfare reform that began in 1996. The number of cases has fluctuated through the years, surging in 2000 to 2001 during a national economic downturn that also affected Montana.
Cash assistance is "small potatoes" in the welfare world, Gardner said, but it's nevertheless a vital part of the overall program.
Features editor Lynnette Hintze may be reached at 758-4421 or by e-mail at lhintze@dailyinterlake.com