Bush Administration Halts Medicaid Rules

The Bush administration on Thursday postponed for up to a year new protections for poor and disabled Americans in managed care, to give federal health officials time to relax the safeguards and give states more control over how they’re carried out.

The action halts rules, issued just before President Clinton left office and scheduled to take effect last spring, that would have given nearly 20 million people on Medicaid many of the rights Congress is trying to grant patients in managed care.

Health and Human Services Secretary Tommy G. Thompson said Thursday that the new version of the rules eliminates excessive mandates and gives states greater flexibility while continuing to provide “needed patient protections.”

Even with the changes, which are a response to aggressive lobbying by state governments and health plans, the rules would guarantee patients emergency room care, second opinions, access to women’s health services and an appeals system if they are unhappy with their care.

The revisions, however, infuriated patient-advocacy groups and Democrats on Capitol Hill, who began to protest earlier this week when they learned of the impending changes. After comparing the new, 277-page regulation HHS proposed Thursday with the original version, critics said patient protections had been weakened in many ways.

An analysis by Democratic congressional aides found that the most serious erosion involves the process for patients to complain if they believe their health plan has denied them needed care.

Under the old rules, the aides said, a dispute over care had to be decided within three days in instances in which a doctor believed a patient’s health or life was endangered. The new version would extend it to “three working days” or two weeks if a health maintenance organization insists it needs more time to gather information.

Another difference cited by the Democrats involves family planning services and treatment for infertility. The Clinton administration version required a health plan to provide such services or, if the organization running the plan had religious or moral objections, to tell its Medicaid patients where such services could be obtained. The new version requires neither.

The rules also loosen requirements that health plans communicate effectively with patients who have poor English skills.

Organizations representing governors and state Medicaid directors, who run the insurance program for the poor and disabled jointly with the federal government, reacted positively.

“I am very encouraged that the [agency’s] goal . . . appears to have been to write a rule that can be practically administered by states,” said Cherilyn Scism, a health policy analyst for the National Governors Assn.

For instance, she said, the new rules--like the old ones--would require states and health plans to study ways that Medicaid patients’ care could be improved. But the new version allows states, not the federal government, to decide which kind of quality improvements should be examined.

The protections for Medicaid patients in private health plans--who account for more than half the 34 million Americans in the program--were required by Congress in 1997.