State Medicaid program well-rated

Washington's Medicaid program is among the 10 best in the nation, according to a report issued Wednesday by a national consumer-advocacy group.

But the same group, Public Citizen, said that nearly every state, including Washington, does a poor job in at least one of its key benchmarks for caring for the neediest and most vulnerable residents.

For instance, Washington ranks fourth for both eligibility and scope of services. The state scored particularly well for "expansive" coverage rules for low-income children and aged, disabled or blind adults and for hospice care.

But the state ranks 26th for reimbursement, a measure of spending per enrollee as well as the fees paid out to medical providers. And it ranks 40th for quality of care, behind even Mississippi and Texas — the worst and third-worst states overall.

The report, "Unsettling Scores," paints "a bleak picture for millions of people" desperately in need of good health care, the authors wrote.

There is "not much 'aid' in Medicaid," contends Public Citizen, which was founded by Ralph Nader.

The report is a sequel to Public Citizen's 1987 survey, "Poor Medicine for Poor People," which called for a Medicaid overhaul. Back then, Washington ranked eighth overall, compared with ninth now.

Doug Porter, Washington's Medicaid director, responded that such reports take crude measurements of complex programs and aren't meaningful reflections on the state's program.

"We are leaders in health care for low-income population," Porter said.

Medicaid is a state and federal insurance program for poor people and disabled adults. In Washington, it covers about 870,000 people, two-thirds of them children whose families earn up to twice the poverty level. Eligibility rules are complex, and being poor doesn't guarantee coverage.

For instance, pregnant women in Washington are eligible with incomes up to 185 percent of the poverty level. But able-bodied adults without kids, regardless of income, generally are ineligible unless they're low-income seniors.

Even Massachusetts, ranked as the nation's best Medicaid program, scored just 645.9 points on a scale of 1,000. Mississippi had the lowest score with 317.8. Washington scored 550. Public Citizen said it chose to measure the states against ideal standards, which accounted for the low scores. The report said the national mishmash of Medicaid programs leaves millions of people ineligible or with inadequate coverage and with a dearth of doctors who will accept them.

Kyung Song: 206-464-2423 or ksong@seattletimes.com