A crowd of nearly 700 health care providers, state lawmakers and experts jammed into a Baltimore hotel meeting room yesterday to work on the state's biggest health issue: how to cut costs and expand coverage by changing how nearly half a million Medicaid patients get their health care.
The conference at the Omni Inner Harbor Hotel was a preview of all of the sticky issues state officials will face as they try to move Medicaid patients into managed care plans -- which coordinate care and restrict which doctors patients can see.
Sponsored by the state Department of Health and Mental Hygiene, University of Maryland Baltimore County and the Milbank Memorial Fund, the conference kicked off a series of 10 public hearings state health officials will hold around Maryland beginning next week.
The officials want input from patients, families, physicians and others.
"We're quite serious about decisions being made with public input," said Dr. Martin P. Wasserman, state health secretary.
Dr. Wasserman's department must get a waiver from certain federal regulations to move Medicaid patients into managed care plans. Earlier this year, state health officials got a stamp of approval from the state legislature to apply for the waiver.
What was debated yesterday was how to design that waiver.
The planned change is a major shift in how Medicaid patients -- mostly poor, sick people -- will get their health care. Now, only about a quarter of these patients are in health maintenance organizations.
Like most states, Maryland is struggling with growing numbers of people on Medicaid and an exploding bill for that health care -- roughly $2.2 billion annually. And like many states, Maryland health officials want to use the waiver to put most of the 467,000 Medicaid patients into HMOs.
The savings would be used to give health care to about 100,000 more Marylanders, who have no health insurance and often end up in expensive emergency rooms.
Several other states -- struggling for answers after Congress rejected major health reform -- are attempting to do the same thing.
During a question-and-answer period, some skeptical community providers voiced their concerns.
"I am concerned that the effectiveness of this waiver will be judged by cost-effectiveness, not by the health of the community," said Jacquelyn Gaines, president of Health Care for the Homeless.
The comment drew vigorous applause.
But despite varying opinions, everyone at the conference got a taste of just how difficult the change will be.
Among the issues to be decided: What will be covered by the benefit package? How will the patients be educated about the system and enrolled? What performance standards should the managed care plans be required to meet?
And should some Medicaid patients -- such as the chronically mentally ill -- be carved out of the program because of their particular needs?
All this must be done with an awareness that Medicaid patients often don't have transportation, can't speak English and face other barriers.
Complicating matters are the physicians, clinics and hospitals that earn money caring for these patients and don't want to lose that income.
If the state receives the waiver, the transition may start as early as next July.
Public meetings on the change in health care for Medicaid patients -- all at 7 p.m. -- will be held at these locations. Information: 410-455-6853 or 410-455-6854.
* Central Maryland -- UMBC, Lecture Hall III, Thursday.
* Montgomery County -- Stella B. Werner Council Office BuildingJune 13.
* Upper Shore -- Kent County Public School System, June 14.
* Garrett and Allegany counties -- Allegany Health DepartmentJune 15.
* Lower Shore -- Deer's Head Center, June 20.
* Western Maryland, Winchester Hall, June 22.
* Southern Maryland -- Charles County Government BuildingJune 27.
* Prince George's County -- Prince George's County CommunitCollege, June 29.
* Baltimore -- War Memorial Building, July 6.
* Harford County -- Bel Air High School, July 11.