Balancing Costs, Benefits of Medicaid Programs

2012 National Conference

CSG Health Policy Task Force
Balancing Costs, Benefits of Medicaid Programs
December 1, 2012

The recent Supreme Court decision on health care reform squarely placed the decision on expanding Medicaid eligibility in the hands of the states. Policymakers are grappling with a myriad of arguments on both sides—and struggling to balance what their states can afford and what their uninsured state residents need. State leaders who have studied the question and arrived at different answers shared their analyses. Dr. Joseph Thompson, Arkansas’ surgeon general, also reviewed his state’s progress in implementing the nation’s first statewide Medicaid payment reform initiative. Other speakers addressed significant reform efforts to control Medicaid costs in their states.

Session Summary:
According to Arkansas Surgeon General Joseph Thompson said the Affordable Care Act has put states on notice that health care policies are going to change. Medicaid will be a major place of impact.

In Arkansas, Thompson said that the state believes it can save money otherwise spent on indigent care by expanding Medicaid eligibility to 138 percent of the federal poverty level. “We have systemically gone through every program in the state to see if we could expand coverage, what could we get rid of,” he said. At the same time, Arkansas is working to change its fee for service payment system to one that bases payment on episodic care. Already five areas of treatment have been reformed, including pregnancy and asthma care.

Dr. Kyle Janek, executive commissioner of Texas Health and Human Services, said Texas is seeking a waiver to increase its Medicaid effectiveness but does not anticipate increasing eligibility. The state currently funds indigent care at the local level through property taxes.
Speakers April Alexander and Matt McKillop also made presentations on ways states can look to save money within their Medicaid programs.

Policy Session: Balancing Costs, Benefits of Medicaid Programs

  Dr. Joseph Thompson, Arkansas Surgeon General


  Download the Presentation: "Health System Improvement: Building a Healthier Future for All Arkansans" in PDF (without audio) or as a Video (with audio)

  Dr. Kyle Janek, Executive Commissioner, Texas Health and Human Services

April Alexander, Regional Director, State Affairs, Molina Healthcare

  Download the Presentation: "Medicaid Cost Containment" in PDF (without audio) or as a Video (with audio)

Policy Session: Program Integrity Efforts by States

  Matt McKillop, Senior Associate, Research, State Health Care Spending Project, Pew Charitable Trusts

  Download the Presentation: "Combating Medicaid Fraud and Abuse" in PDF (without audio) or as a Video (with audio)

Speaker Biographies:

April Alexander, Regional Director, State Affairs, Molina Healthcare
April Alexander serves as Regional Director of State Affairs at Molina Healthcare in Sacramento, California, where she manages the legislative affairs for the western region Molina states.  In this role, she works with the Washington, California, Utah and New Mexico Molina health plans to develop and implement legislative, regulatory and political strategy.  

Before Molina, she served as the Director of Legal and Regulatory Affairs for the California Association of Health Plans,  where she was responsible for regulatory advocacy on behalf of the health plans that participate in California’s state health programs and for providing legal and policy support on a variety of Medicaid and CHIP legislative issues.  Before entering the private sector, she served as licensing counsel at the California Department of Managed Health Care. 

April holds a J.D. from University of the Pacific – McGeorge School of Law and a Bachelor’s degree in Political Science from Cal State, Chico.  

Kyle Janek, MD, Executive Commissioner, Texas Department of Health and Human Services

A lifelong Texan, Kyle Janek was born and raised in Galveston. After serving eight years in the Texas House of Representatives, he was elected to the State Senate for an additional 13 years. In September 2012, he was appointed by Governor Rick Perry to be Executive Commissioner of the Texas Health and Human Services Department, a $16 billion operation that oversees health and human services, including Medicaid.

Senator Janek received a Bachelor of A&M University in 1980. He went back to his hometown to attend medical school at the University of Texas Medical Branch. Upon receiving his Doctor of Medicine degree, he took a residency in anesthesiology at UTMBi. He served as a Chief Resident his final year. A board-certified anesthesiologist, Dr. Janek was in private practice at Lakeway Regional Medical Center near Austin before accepting Gov. Perry’s appointment.
Dr. Janek has been a sponsor of medical missions to Central America. He is an active sponsor of local little league teams and a member of both the Greater Southwest Houston and the Fort Bend Chambers of Commerce

Matt McKillop, Senior Associate, Research, State Health Care Spending Project, Pew Charitable Trusts

Matt McKillop is a senior associate for Pew’s States’ Health Care Spending project, a joint initiative with The John D. and Catherine T. MacArthur Foundation, that analyzes health care spending across the 50 states over the past decade, delves into the factors driving up costs, and examines the effectiveness of cost-containment efforts. McKillop coordinates the project’s research on cost-containment strategies.

Previously, he conducted research on other state fiscal issues, such as pension and retiree health care benefits and states’ budget balancing measures. He also helped lead a cross-cutting communications team within the Pew Center on the States. Prior to Pew, he led advocacy and community organizing campaigns for So Others Might Eat, a nonprofit organization that serves poor and homeless residents of the District of Columbia.

McKillop holds his master’s degree in public policy from The George Washington University and a bachelor’s degree in political science from Kalamazoo College.

Joseph W. Thompson, MD, MPH

Dr. Joe Thompson’s work is centered at the intersection of clinical care, public health and health policy. He is responsible for developing health policy, research activities and collaborative programs that promote better health and health care in Arkansas. Dr. Thompson works closely with the governor’s office, the Arkansas legislature and public and private organizations across the state on relevant health policy topics.

Dr. Thompson has led vanguard efforts in planning and implementing health care financing reform, tobacco- and obesity-related health promotion and disease prevention programs. He was the lead architect of the Tobacco Settlement Act of 2000 and instituted the Arkansas Health Insurance Roundtable. Under his leadership, ACHI helped pass the Clean Indoor Air Act of 2006, documented the state’s success in halting progress of the childhood obesity epidemic, and helped implement ARHealthNetworks, Arkansas’s health care benefits waiver for low-income workers.

Dr. Thompson has been at the forefront of both Arkansas’s leading-edge efforts against childhood obesity and in national efforts to reverse childhood obesity as the former Director of the Robert Wood Johnson Foundation (RWJF) Center to Prevent Childhood Obesity.

He currently serves on the Arkansas Board of Health and is past president of the Arkansas Chapter of the American Academy of Pediatrics. Nationally, Dr. Thompson serves on the board of the Campaign to End Obesity and of AcademyHealth, as well as serving on Institute of Medicine’s standing committee on childhood obesity.  He is author of numerous articles and publications that reflect his research interests in the areas of health and health care including access, quality and finance.

Dr. Thompson earned his medical degree from the University of Arkansas for Medical Sciences and Master of Public Health from the University of North Carolina at Chapel Hill. He served as the RWJF Clinical Scholar at the University of North Carolina at Chapel Hill, the Luther Terry Fellow in Preventive Medicine advising the U.S. assistant secretary of Health in Washington, D.C., and the assistant vice president and director of research at the National Committee for Quality Assurance in Washington, D.C.  In 1997, he served as the First Child and Adolescent Health Scholar of the U.S. Agency for Healthcare Research and Quality (then the U.S. Agency for Health Care Policy and Research) before returning to Arkansas.