{"id":1106,"date":"2019-09-25T19:13:47","date_gmt":"2019-09-26T02:13:47","guid":{"rendered":"http:\/\/danschmidtforsenate.com\/blog\/?p=1106"},"modified":"2019-09-25T19:13:47","modified_gmt":"2019-09-26T02:13:47","slug":"another-waiver","status":"publish","type":"post","link":"https:\/\/danschmidtforsenate.com\/blog\/?p=1106","title":{"rendered":"Another Waiver"},"content":{"rendered":"\n
\"\"<\/figure>\n\n\n\n

We have tipped past the equinox so we are officially in fall\nseason. But the passel of work the Idaho Legislature dropped on the Department\nof Health and Welfare this last legislative session is churning out another\nwaiver request. So, it\u2019s still Waiver Season.<\/p>\n\n\n\n

If you\u2019ve forgotten, after voters approved Prop 2 last\nNovember, the Idaho legislature felt the need to fix it. This same legislature\nwho had not studied the options, had not debated any proposals for six years,\ndecided last session they knew better than the voters about how to expand\nMedicaid eligibility for Idaho residents. So, they got busy passing laws,\nGovernor Little signed them, and so our taxpayer funded agencies are doing the\nwork as directed.<\/p>\n\n\n\n

The first waiver request, Idaho Choice, is dead. It got nixed\nby the Feds because it was going to cost more and provide worse coverage. But\nsince it\u2019s what the Idaho legislature wanted, the Idaho Department of Insurance\nand DHW did the work of researching it, holding hearings, taking testimony, and\nsubmitting the request.<\/p>\n\n\n\n

The second waiver \u201cWork Requirements\u201d has finished with\npublic input. All who testified were opposed and over 90% of the 1800 written\ncomments were opposed. It will be submitted to the feds in the coming weeks. It\nwill be approved, then contested in court.<\/p>\n\n\n\n

The third waiver now open for public comment is a head\nscratcher. But that is only if you don\u2019t understand the intent. This third\nwaiver requires all Medicaid participants who want to get family planning care\nsomewhere other than with their designated primary care provider (PCP) to\nobtain a referral. This is from the same legislative body who bows before the \u201cfree\nmarket\u201d and salutes school choice. I wonder where the Freedom Foundation is on\nthis one.<\/p>\n\n\n\n

The reason I\u2019m scratching my head on this one is because, it\u2019s\nwhat Idaho Medicaid already does. If you enroll in Medicaid you can choose a\nPCP or you are assigned to one. That PCP is supposed to \u201cmanage and coordinate\ncare\u201d. That means making referrals when the PCP decides she needs some help\nfrom a specialist.<\/p>\n\n\n\n

So why the direct reference to \u201cfamily planning\u201d for this\nstatutory referral requirement? Most agree it\u2019s a weak attempt to shunt money\naway from Planned Parenthood, where some low-income women get their care. <\/p>\n\n\n\n

But as I read the waiver, there are no consequences for the\nPCP if they give the referral, and there are no consequences for the specialist\nif they provide care without the referral. <\/p>\n\n\n\n

A while back a patient came in about his chronic medicines\nand asked me to give him a referral to a dermatologist. \u201cWhy?\u201d I asked. <\/p>\n\n\n\n

\u201cOh, I have these spots.\u201d He held out his hand.<\/p>\n\n\n\n

\u201cThose are seborrheic keratoses. They are benign. You will\nget more as you get older. Do you want me to freeze them off? They, or others\nwill come back. It\u2019s OK just to watch them if they aren\u2019t bothering you.\u201d<\/p>\n\n\n\n

\u201cI want to see a dermatologist.\u201d<\/p>\n\n\n\n

A month later I get the letter from the dermatologist\ntelling me the patient had seborrheic keratoses and she had frozen them off.<\/p>\n\n\n\n

One way to control health care costs is to provide the most\nappropriate care in the lowest cost setting. If I\u2019m going to have to fight with\na patient about referrals, and believe me, it can be a fight, what\u2019s in it for\nme to get all this ill will? Where\u2019s the leverage?<\/p>\n\n\n\n

As far as I know, this is the only statute on the books in\nIdaho about patient referrals. This sort of bureaucracy does not befit a conservative;\nbut I guess it\u2019s worth it to them if it hurts Planned Parenthood, even a just little\nbit.<\/p>\n\n\n\n

 If the legislature\nwants to get in the business of writing laws to manage health care, I suggest\nthey do a better job. But this waiver isn\u2019t worth arguing over. It\u2019s a dog\nwhistle; don\u2019t bark.<\/p>\n","protected":false},"excerpt":{"rendered":"

We have tipped past the equinox so we are officially in fall season. But the passel of work the Idaho Legislature dropped on the Department of Health and Welfare this last legislative session is churning out another waiver request. So, … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":1107,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8,4],"tags":[],"_links":{"self":[{"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/1106"}],"collection":[{"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1106"}],"version-history":[{"count":1,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/1106\/revisions"}],"predecessor-version":[{"id":1108,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/1106\/revisions\/1108"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=\/wp\/v2\/media\/1107"}],"wp:attachment":[{"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1106"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1106"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/danschmidtforsenate.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1106"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}