WASHINGTON (AP) – States should be given more freedom to enroll the poorest of the poor into managed care programs and adopt changes that have worked elsewhere, a Medicaid reform panel recommended Friday.

However, Democratic lawmakers have contended that the panel, formed nearly 18 months ago by the Bush administration, has lacked independence. Now that the Democrats control Congress, some analysts are predicting the group’s recommendations will be “dead on arrival.”

“While some in Congress thought this effort would bear fruit, I see no proof of that in this report,” said Rep. John Dingell, D-Mich. “It is the job of the Congress to review the Medicaid program and legislate necessary changes, not a hand-picked commission stacked against working families.”

Medicaid is the federal-state partnership that provides health coverage to about 55 million Americans. It’s one of the fastest-growing programs in most states. Officials warn that changes are needed to enable the program to continue without forcing states to slash other government programs, such as education or new roads.

Many of the commission’s recommendations were broad and lacked specifics. But Don Sundquist, a former Republican governor from Tennessee, said they provide a roadmap. He said the panel wanted to stress that states should get more leeway to provide the benefits they think will best serve residents.

Sundquist said states proved they had the best interest of their residents in mind when they led the overhaul of welfare programs.

“If something works, they shouldn’t have to go, ‘Mother may I’ to the government,” Sundquist said.

Angus King, a former governor of Maine who was an independent, noted that the commission’s recommendations also sought more coordinated care for the poor. Patients should be assigned a “medical home,” either an insurer, family doctor, or some other professional who would be reimbursed for tracking a patient’s condition and making sure they got the most appropriate care.

Health and Human Services Secretary Mike Levitt appointed 15 voting members to the commission when it was started about 18 months ago. Thirteen were present Friday, with one member voting against the panel’s recommendations and another abstaining.

The panel also recommended several tax breaks. For example, people who take care of family members at home to prevent that person from entering a nursing home should get a tax cut.

Also, employers who offer long-term care insurance as a benefit should get federal and state tax breaks.

A few dozen advocacy groups and lobbyists watched the two days of meetings. William Vaughan, a senior policy analyst at Consumers Union, said the greater flexibility the commission called for is really code for letting states cut eligibility and benefits.

“That really gets into the Nov. 7 election. Is this relevant anymore?” Vaughan said. “There’s a whole lot of members coming in who don’t want any part of touching Medicaid if it’s going to mean people being put out on the street or care no longer getting covered.”

Sundquist, who served as commission chairman, said he was pleased with the final results and he predicted that several governors would be, too.

“I just hope that Congress will work like we worked,” Sundquist said. “The people will demand it, I think.”

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