Newspaper article THE JOURNAL RECORD

States Experiment with Medicaid

Newspaper article THE JOURNAL RECORD

States Experiment with Medicaid

Article excerpt

OSSINING, N.Y. -- It still hurts, almost literally, when Maribel Ramos remembers what her medical care was like before this year.

"I would get these migraine headaches and these anxiety attacks, and I would have to go to the emergency room and wait and wait, with the kids running around," says the mother of two young boys. "Medicaid was not working out that great."

Then Ramos, along with 29,000 other welfare mothers, was moved into managed care. Westchester County's goals were clear: keep people healthier and, not incidentally, save money. Ramos seems thrilled. Taxpayers will also be delighted if savings continue at the projected pace of $8 million a year. Westchester's program, started Jan. 1, was the first in the state to mandate managed care for Medicaid recipients. It may soon have company. New York hopes to join 13 other states that have federal permission to experiment with Medicaid. It would be the largest such experiment by far. New York, with its considerable population of poor people on public assistance, plans to extend mandatory managed care beyond single mothers to the old and disabled and to people with AIDS, chronic mental illness and drug or alcohol problems. The state's plan would eventually cover all of its 3.6 million Medicaid recipients and save $1.5 billion over five years, says Frances Tarlton of the state Health Department. "We want to make managed care generally the way Medicaid patients get their health care," Tarlton says. In terms of translating one county's program to the entire state, however, Westchester is far from standard. The third richest in the state, with a population of just under 900,000, it encompasses everything from cities to horse farms to the bedroom villages that make it a prototypical suburb. It has plenty of doctors and a modest welfare roll. It's far different from New York City's teeming neighborhoods with heavy Medicaid caseloads or empty rural counties upstate with entrenched poverty and little managed care in place. Also, it has so far enrolled only recipients of Aid to Families With Dependent Children -- generally single mothers and their kids, plus the few children of home relief families. One of those single mothers is Ramos, 25, who has the same kind of health plan as millions of middle-class Americans. For those accustomed to freely choosing their own doctors, managed care can seem like a step down. For Ramos, it's a big step up. "The doctor is much better. He's good to my kids," she says at her walkup apartment in Ossining. She is still covered by Medicaid. But now instead of heading for an expensive emergency room with health problems, she calls her doctor and gets advice or an appointment. Officials cite multiple benefits. Welfare families stay healthier with primary doctors guiding their care and immunizing children on schedule. …

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