There has been a lot of talk coming out of Washington, D.C., in the past several months about making Medicaid a “block grant” program.  The new administration is telling us that by making Medicaid a block grant program they are giving more control over Medicaid to the states.  The States, the Administration tells us, are in a better position to administer their Medicaid programs and to weed out fraud and other abuses.

It’s interesting to me that when the government intends to give people fewer benefits, they talk about increasing people’s choices and giving more freedom to the states.  Make no mistake about it, though, turning Medicaid into a block grant program will result in fewer benefits for the people who need the program.  The amount of money allocated to the Medicaid program will drop considerably and benefits will be cut.

Assuming my statement is true, which I believe it to be, should you care?  Many people might say “Good!  I hope they do cut the Medicaid program substantially.  Bunch of deadbeats living off the government.”  Or, they might say “Good!  There’s too much fraud in the Medicaid program.  People getting benefits they don’t deserve.”

Reducing or eliminating fraud is something most of us can get behind.  Why should the government spend money (the money at least 55% of us pay in income tax) to scammers and frauds.  I can’t speak to whether or not there is widespread fraud in the Medicaid program, but from my perspective, I don’t see fraud.

When I apply for Medicaid for a client, my client has to provide the Medicaid office with five years’ worth of bank statements for every account that he owns or has owned.  My client has to certify as to any gifts that he may have made in the past five years.  The Medicaid office reviews my client’s documents for several months before approving my client for benefits.

After my client is awarded benefits, even years after my client is approved for benefits, the Medicaid office does cross-checks with the Internal Revenue Service to see if my client’s social security number shows up on any financial accounts that my client failed to reveal in the application process. If the Medicaid office finds any such accounts, the office sends a letter to my client asking him to explain why he failed to disclose the account.  In most cases, the account was a closed account that my client simply forgot to disclose, but the Medicaid office does find the undisclosed account.

So, do I see fraud in the Medicaid application process?  No.  I don’t.  Does that mean that there is no fraud in the Medicaid program?  No.  I’m sure there is some fraud, but I don’t believe that you should throw out a good program simply because there is some fraud.

Would allowing the various states wholesale control over their Medicaid programs equate to something better for the people receiving benefits?  I doubt it.  What it will amount to is Medicaid programs that vary greatly from state-to-state.  New Jersey’s Medicaid program and Arizona’s Medicaid programs will be so different, for instance, that they will be unrecognizable to the people being benefitted by the programs.

Does this make sense?  No.  My clients, for instance, need Medicaid to pay for their long-term care needs—care in a nursing home, care in an assisted living residence.  Someone needing care in a nursing home in New Jersey does not have vastly different care needs than someone needing care in a nursing home in Arizona, so why should the ability of a person in New Jersey to qualify for Medicaid vary so much from a person in Arizona.

Now, you might be someone who thinks, I don’t care. Medicaid is out of control and the costs need to be reined in.  To me, that’s an okay way to think, until, of course, you or someone you know needs Medicaid.  But at least it’s an honest way to think about Medicaid.  Saying that making Medicaid a block grant program is going to give more freedom to the states to administer their Medicaid programs is disingenuous.  Code phrases such as “more choices” and “states’ rights” are really just ways of saying fewer benefits to you and me and those we love.