WILLIAM DONALD SCHAEFER, Governor

Preamble

WHEREAS, During the 1988 Interim a Special Joint Legislative
Committee on the Medical Assistance Program was established to
undertake a comprehensive review of Maryland's Medical Assistance
Program; and

WHEREAS, The Special Joint Legislative Committee found that
there is currently no well defined public policy for Maryland's
Medical Assistance Program; and

WHEREAS, The Program's eligibility and service limits have
been established administratively and on a piecemeal basis
through the budget process and by regulations; and

WHEREAS, The Program lacks cohesiveness and a sense of
overall direction; and

WHEREAS, The effects of changes made to the Program are
seldom measured against initial projections; and

WHEREAS, While the The Program provides a wide array of
services, those services are afforded to only a relatively
limited segment of the indigent population; and

WHEREAS, While State expenditures for the Program have
almost doubled between F.Y. 1982 and F.Y. 1989, but Program
enrollment has declined; and

WHEREAS, The Program provides relatively good reimbursement
for institutional services such as hospitals and comprehensive
care facilities, but relatively poor reimbursement for
noninstitutional services such as physician visits; and

WHEREAS, Program reimbursement practices provide little
incentive There is a need to provide better Program reimbursement
procedures for less expensive and preventive care; and

WHEREAS, Program recipients have good access to hospital and
nursing home care but may have difficulty finding a physician to
provide primary health care; and

WHEREAS, Access to and continuity of care for Program
recipients are hampered by shortages of primary care providers in
areas where Program recipients reside, a lack of consumer
education about good health habits, limits on coverage of certain
types of providers and on services for people with particular
disabilities, and a lack of coordination among the State agencies
and private providers involved in the Program; and

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