Tribune Editorial

It can be argued that people in the U.S. whose health care is covered by Medicaid are among society’s most vulnerable members. They are the least likely to have any kind of medical insurance.

If persons who meet Medicaid eligibility are to receive health care at all, they have to depend on a health care facility and its staff to treat them in anticipation that reimbursement will make it worthwhile for the providers.

The federal government normally comes to mind when people talk about Medicaid. And it does cost the nation’s treasury, for its share, about $200 billion annually for the 55 million people who get Medicaid health care.

But the pertinent fact is that it’s a program administered by the states, and there is no uniformity from state to state in how much a medical provider is reimbursed for providing Medicaid care.

In stark terms, the federal and state combination of reimbursement would make it seem that it’s worth more to treat poor and disabled people in Minnesota than those in North Dakota. Not only does that neighbor make it more palatable to providers to give Medicaid care but also hospitals and health care givers in South Dakota and Montana do better than in this state.

That should change, because a Medicaid patient here receives health care as good as provided in the neighboring states. But that would cost North Dakota money — a lot of money.

An independent study ordered by the 2005 Legislature looked at costs and reckoned that to bring the reimbursement level up to some kind of adequacy, there would have to be $417.7 million for Medicaid reimbursement in the budget of the Department of Human Services. The baseline budget request by Human Services for the next biennium comes in at $389.8 million, which in his executive budget, Gov. John Hoeven increased to $401.9 million.

The study concluded that to put Medicaid patient reimbursement to hospitals and providers on an even keel with how Medicare pays, the budget amount would have to be $438.3 million.

True, North Dakota has a budget surplus, but it can’t pay for everything.

Phasing in increases may hold promise, even though the cost to providers to provide health care keeps rising relentlessly.

There is an issue of fairness. It simply is unjust that a hospital in Minnesota should receive a 44.3 percent greater reimbursement rate than a hospital in Bismarck that gives identical care.

North Dakota can be smug about having the lowest rate of some things. Crime rates come to mind.

But it’s nothing to be proud of that treating a Medicaid patient is done at one of the lowest payment rates in the nation.

It’s no answer to reduce poor or disabled persons’ access to health care or cutting the quality. The list of mandatory services that Medicaid will pay for is short enough as it stands. The program doesn’t even have to pay for physical therapy or respiratory care for people dependent on ventilation.

The Legislature asked to be informed about the adequacy of the funding needed to reimburse hospitals and other providers that have Medicaid patients. The state paid $100,000 for the study alone.

Now the lawmakers have some hard choices to make. The amount of the appropriation to the Human Services appropriation could be raised, or left unchanged. What would be unacceptable is for health care to vulnerable North Dakotans to be curtailed.