As states focus on cutting Medicaid benefits and provider payments, many have not adequately considered alternative measures that can be adopted to reduce costs in the program without harming Medicaid beneficiaries. This fact sheet identifies actions that, when taken correctly, can save states money without impacting eligibility, services or imposing harmful co-payments. It can be used by advocates as they engage in policy and litigation advocacy with state officials.
- Cost-saving measures for inpatient hospital services:
- Require second opinions for specified procedures. (CO, IL, IN, NJ, OR).
- Pre-surgical days limited to 1 unless medically justified. (DC, IL). In VA, any number of pre-surgical days before elective surgery must be medically justified.
- Weekend admissions:
- Weekend admissions must be medically justified. (DC, VA).
- Non-emergency weekend admissions must have procedures same or next day. (PA).
- Weekend admissions limited to hospitals providing full services every day. (WI).
- Length of stay less than 24 hours considered outpatient except for newborns. (IN).
- All Medicare benefits/days are exhausted before Medicaid billed. (ME).
- Allow for 3 administrative leave days to facilitate transfer to less restrictive setting. (NC).
- Check for double-billing, e.g., by hospital-based physicians and by pharmacies and hospitals for drugs at the time of discharge. (NY).
- Perform diagnostic tests on outpatient basis prior to inpatient admission (except by prior authorization).
- PA?s Medicaid managed care program saved money by using ?observation day? rates for low-acuity patients during short hospital stays (less than 2 days) rather than the higher rate normally used for inpatient care.
- Reduce readmission rates: 16% of people with disabilities covered by Medicaid (excluding dual eligibles) were readmitted to the hospital within 30 days of discharge. Half of those readmitted had not seen a doctor since discharge. Using a nurse discharge advocate to arrange follow-up appointments and conduct patient education or make follow-up calls has yielded reductions in readmission rates. One CO project reduced its 30-day readmission rate by 30%.
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