WHAT FLEXIBILITY BUYS YOU:

West Virginia and Kentucky Alter Medicaid (THE ASSOCIATED PRESS, 5/24/06)

West Virginia families served by Medicaid could face a reduction in benefits if they refuse to sign contracts promising to show up for doctors' appointments and to use the emergency room only for emergencies. Kentucky, meanwhile, is putting new limits on prescriptions and visits to therapists.

They are the first two states to take advantage of a new law that makes it easier to mix and match which residents get which benefits under Medicaid, the state-federal program that provides health insurance coverage to about 55 million low-income people.

In years past, when states provided a health benefit for Medicaid beneficiaries, they had to do so for all participants in their state. The concept, called comparability, guaranteed comprehensive health insurance coverage for the poorest of the poor.

Now, comparability is out. Flexibility is in.

Governors had seen the comparability requirement as a straitjacket, forcing them to drop people off the Medicaid rolls when trying to reduce the program's explosive costs. The governors view the changes approved by Congress as a way to scale back coverage for some rather than drop people into the ranks of the uninsured.