The debate over Medicaid reform isn't just for policy wonks. It is crucial to any family facing long-term care for an older family member. With baby boomers becoming senior citizens in a few years, that's a lot of families.

Reform was a hot topic at the National Governors Association conference last week. Protesters demanded that governors help force Medicaid to turn to home- and community-based long-term care for seniors - which most Americans would prefer anyway - instead of institutional care.

Ballooning crisis

They had the right idea. The soaring cost of Medicaid - $300 billion a year nationally - is becoming unsustainable. Medicaid costs Ohioans $11 billion a year and takes up a third of the state budget - much higher than the national average of 20 percent. That will soon grow to half of Ohio's budget. The National Conference of State Legislatures reports that states' Medicaid costs will jump 13 percent in 2005.

Nursing homes overused

The fastest-growing part of that cost, along with prescription drugs, is nursing-home care, which has risen 61 percent in eight years in Ohio, even while the number of people in those institutions has dropped 7 percent.

Yet instead of encouraging far less expensive programs that offer people the chance to remain in their own homes longer, Medicaid pushes clients into institutional care unless states receive waivers for alternative programs.

In Ohio, the Passport home care waiver program has shown promise. According to the Council on Aging, nursing home care cost Medicaid $147 a day in 2001, compared with only $31 for Passport. But Ohio insists on pouring more than 83 percent of its long-term dollars into institutional care, with less than 17 percent for home care. That ratio is one of the worst in the nation, according to Governing magazine.

Ohio Secretary of State Ken Blackwell, a longtime champion of Medicaid reform, has been taking state lawmakers to task on this issue. He says they've rigged the game in favor of the politically powerful nursing home lobby, writing the reimbursement formula into state law and paying for beds whether they're used or not.

An antiquated model

A state commission on Medicaid reform appears to be nibbling at the problem. Among other ideas, it's considering filling Ohio's empty nursing home beds with battered women, drug-addicted teens and others.

Instead, it should be trying to move Ohio away from what Blackwell correctly calls an "antiquated" Medicaid model that relies too much on those beds.

Ohio's families, and taxpayers, deserve that kind of real reform.