I Love A Good Drama

Should States Opt Out Of Medicaid?

Some states are complaining that the massive expansion of Medicaid under the Patient Protection and Affordable Care Act (aka, ObamaCare) will impose so many new costs and regulations that they are considering opting out of the 45-year-old program.

That would be a big step, one that no state has ever taken.  Is it advisable?  Not if there is a reasonable way to resolve the current fiscal and regulatory challenges.  Is it doable?  Probably, but it would mean big changes.

Here are the changes:

First, Medicaid, through Targeted Case Management is the largest funding stream in child welfare.  This would mean the state would have to drastically cut its foster care programming.

Perhaps one could argue that a foster child could be covered through state insurance exchanges.  Then again, one could ask why insurance companies will not cover basic psychological services and congenital conditions, or even recognize autism and approve coverage as a medical condition.

Now, you have a larger population of children who will not have access to medical resources.  

Traditionally, when a child cannot access basic medical coverage, the default is placement in the foster care system.  The child is removed, voluntarily, from the home to be placed in residential or even long term care.  The grounds for this removal are neglect, failure to provide for the necessary care of the child.  Now, the foster care population increases ten-fold.

One reason why the federal financial participation rate is so low for many states, states having to fund a large portion of Medicaid, is because the state attorney general Medicaid Fraud Control Units do absolutely nothing, some states are starting, in terms of ending Medicaid fraud, waste and abuse.  In stopping the pilfering of the funds, the federal financial participation rate would increase.  Unfortunately, states prefer to sustain the percentage penalty rather than come into compliance with the federal reimbursements.  It's cheaper to pay the fine, so to say.

A significant area of Medicaid fraud is in child welfare.  Since the States will do nothing to stop the levels of fraud in child protective services and foster care, perhaps States should opt out of Medicaid.  

Stop the money, you stop the fraud.

Opting out of Medicaid could be considered as a form of population control.  Society will quickly learn that it will not provide for its children, reducing the population in birth rates and through increased infant mortality.  The reduction in the future older generation will be a reduction in Social Security payments.  But why stop there, cut out Medicare, too.

Call it survival of the fittest.

Perhaps States should shut down public education, as Medicaid funds certain activities.  In this manner, those children who make it to adulthood can now, without the benefits of an education, can become the new, low pay workforce and would decimate the entire union structure.  In turn, the GDP would increase as the U.S. would lead the world in cheap manufacturing.

There would no longer be foster children to be used as lab rats for clinical trials, all funded through Medicaid.  Less drug testing and drug approvals of psychotropics would lessen dependence on therapy, saving even more money for the state.

Alas, there would be a sizable workforce in the human service industry that would become unnecessary and unemployed, but we could retrain them to be the undertakers who would clean up the people who would die for lack of medical coverage.

Illegal immigrants would no longer want to come to the U.S. and there would be a massive exodus of U.S. citizens, fleeing the land from the horror and chaos of the States opting out of Medicaid.

Is it a good idea for States to opt out?  Sure.  I love a good drama.