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    Cleveland's Early Medicaid Expansion Paying Off


    The hospital also ended up spending less than it budgeted, saving an average of $150 on each patient every month.

    "Better care, better outcomes, better costs," Cebul says.

    Outside of Cleveland, a handful of cities and states expanded Medicaid earlier than the rest of the nation. But results haven't always been so promising.

    In Oregon, for example, emergency department use went up when patients got Medicaid, not down.

    They ran their experiment differently, essentially giving Medicaid coverage on a random basis while leaving others uninsured. And they didn't do any of the oversight that Cleveland did. (A subsequent large scale effort to coordinate care in Oregon has achieved promising early results.)

    Matt Salo leads the National Association of Medicaid Directors. He says no one program will have all the answers. Instead, at a time when health reform is changing the way patients everywhere are treated, Salo says, there's a lot at stake in trying to figure out what works.

    "You know we've got 50-plus states who are out there actively trying to steal best practices and good ideas and reform principals from other states," he says.

    But Carmen Smith knows this is working for her. She recalls how before getting Medicaid she was using a scooter to shop at Wal-Mart. Now, she's rides her bike to get around town.

    "I'm really excited 'cause I'm doing a good job. I feel so good about myself. I get off my bike and I'm like out of breath. I'm not tired." Smith says.

    She says she can't wait to call her nurse and talk about blood sugar levels.

    Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

    Wed, Jul 30 2014

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