Medicaid Regulations Needed to Protect the Poor and the Elderly

The Medicaid and Medicare programs, combine under CMS – the Center for Medicaid and Medicare Systems – though not perfect, are a lifeline for the impoverished and the elderly. However, because they are government sponsored, they are more susceptible to breaches of security. New Medicaid regulations are needed to enforce tighter security so the poor and elderly don’t become victims of information download and so there should be greater equality between the publicly and privately insured.

The situation today

There are currently over 130 million Americans that rely on the Medicaid and Medicare healthcare payment systems. Due to the careful data collection and EHR (electronic health record) system under current Medicaid regulations, these users are exposed to information download that might actually be a breach of their personal security. Private insurance users, alternatively, are not exposed to the same information download and potential security threats.

What needs to change

Craig Konnoth, University of Colorado Law School professor, studied this issue and published his findings, called “Health Information Equity,” in the University of Pennsylvania Law Review. What he found is that the government health system data collection gives Medicaid and Medicare patients health information inequity, and he urges the higher ups to reconsider legislation to provide for health information equity. 

CMS gives health researchers access to the EHRs of registered patients so they can use them toward positive health research, in and of itself a very good thing. However, the potential and practical option of data breaches is enormous, putting users in the way of easy financial and medical fraud as well as identity theft. In fact, 90% of healthcare organizations that had access to the records admitted they knew of data breaches between the years 2014 and 2016. 

These security concerns have had an enormous impact of the way Medicaid and Medicare patients seek treatment. Over half of a million people in the US did not seek out treatment for cancer due to security concerns, and many more do not go for mental health help for the same reason.

Federal law does not force privately funded insurance plans to provide information to government offices. Konnoth, however, wants to challenge that, and advocates the government taking health information form privately funded insurers at the same rate as public health funds. He says that CMS has the ability to penalize doctors who don’t disclose patient information, and CMS can get this data through doctors who treat patients both privately and through Medicaid – 90% of doctors accept Medicaid as payment.

He also proposes Medicaid regulations that would require doctors to see patients for regular checkups. This would accomplish two goals: one, as a preventative measure that would catch signs of illness before symptoms are strong, and two, as a systematic way to collect patient health care data. Insurance companies could offer benefits for patients who choose to take part in this program in the form of lower insurance costs or some type of gift. The program would ultimately save the company money, since the point is to catch illness earlier when it’s more treatable.

If these medicaid regulations are instituted, it can even out the playing field for public and private patients.