* Every time there’s a recession in this country, Medicaid spending becomes a major issue for the states. Back in the early 1990s, it was said that Medicaid was eating states’ budgets alive. Now, the Associated Press refers to the program as a budgetary “monster”….

In Illinois, Medicaid sucks up more money than elementary, secondary and higher education combined.

“Medicaid is such a large, complicated part of our budget problem, that to get our hands around it is very difficult. It’s that big. It’s that bad,” said Illinois Sen. Dale Righter, a Republican and co-chairman of a bipartisan panel to reform Medicaid in Illinois, where nearly 30 percent of total spending goes to the program.

* Some stats…

During the Great Recession, millions of people relied on the Medicaid safety net. Between 2007 and 2009, the number of uninsured Americans grew by more than 5 million as workers lost jobs with employer-based insurance. Another 7 million signed up for Medicaid.

Just when caseloads hit their highest point, the nation’s new health care law required states not to change the rules on who’s eligible for Medicaid. That means states can’t roll up the welcome mat by tightening Medicaid’s income requirements.

* And a bit of perspective…

Contrary to stereotype, it’s the elderly and disabled who cost nearly 70 cents of every Medicaid dollar, not the single mother and her children.

That’s a very good point. While over half of the recipients are children, it’s the elderly and the disabled who cost the most, even though they represent only 20 percent of the recipient population.

* There are a handful of ways to cut medical costs. Cut payments to providers, like doctors and hospitals, cut benefit levels to recipients, kick people off the programs, reform the way payments are made.

Providers in Illinois are already receiving fairly low levels of disbursement and Illinois has one of the lowest costs per patient ratios of any Medicaid program in the nation. So, moving on those two items just isn’t very realistic, although some tweaks can be made.

That leaves things like managed care, which the Republicans have been pushing and the state is already doing to some extent, and kicking people off Medicaid. They aint’ gonna kick old people off because they vote, so that leaves everyone else. One area being looked at hard is undocumented immigrant children…

One area some committee members were concerned about was the practice of the state paying for health insurance for more than 50,000 undocumented immigrant children. Unlike other sections of the state-funded children’s health care program, the care for undocumented children doesn’t receive any federal match. All of the funds must come from the state’s general revenue fund, according to Julie Hamos, director of the Department of Healthcare and Family Services and a former Democratic state legislator.

“We see the issue of serving undocumented (immigrant) children as a policy issue, one that we’re proud of and one this governor supports, so we are not proposing changes in reducing eligibility for undocumented children,” Hamos said.

However, advocates have noted that health care for children is relatively inexpensive when compared to adult needs.

* Another thing being looked at is requiring recipients to more regularly prove their income levels qualify them for benefits…

One pay stub annually is all a family needs to provide right now to show annual income.

State Rep. Patti Bellock, R-Westmont, who co-chairs the committee, has introduced legislation that would change that requirement to proof of a month’s worth of income. This provides a better sense of what a family makes over the course of a year, proponents claim.

But…

Not everyone wants to see these changes, however. State Rep. Mary Flowers, D-Chicago, said that it’s a waste of state resources to chase after people whose income is likely constantly in flux.

“Income varies from week to week, or it could be from day to day … you’re really complicating the situation, making it a lot worse, and you’re clogging up the system chasing after the cheats as opposed to providing the services which you are suppose to be providing,” Flowers said.

Making any changes that might bump people out of Medicaid could be tricky. A clause in the federal health care overhaul act says that states can’t make “eligibility standards, methodologies, or procedures” more restrictive than what was in place as of March 23, 2010, without federal approval.

Both the House and the Senate have bipartisan committees set up to look at all these issues and more. The Senate’s committee is meeting this morning.

Thoughts?