The Bush administration’s Medicaid Commission, established in 2005 to study ways to "modernize" Medicaid, has released its final recommendations on the future of the federal health care program for low-income individuals who cannot pay for their own care.

The commission’s proposals focus largely on long-term care, the fastest growing part of the Medicaid budget. As previously reported, one of the cost-cutting proposals is to allow states to shift those eligible for both Medicaid and Medicare, including nursing home residents, into managed care plans.

The commission, created as part of a congressional budget resolution in 2005, was charged with the task of issuing two reports. The first suggested ways to cut $10 billion from the Medicaid program over five years, while the second report, just released, makes long-term recommendations for the program. Health and Human Services Secretary Michael O. Leavitt chose the panel’s 12 voting members. Democratic lawmakers were offered a non-voting role, but declined to participate, with Sen. Jay Rockefeller (D-WV) calling the study commission “nothing but a farce.”

The long-term care recommendations focus on ways to persuade those in need of long-term care to take more responsibility for paying for their own care and ways to give states more flexibility to cut costs by departing from federal Medicaid rules.

In addition to the managed care proposal, the report calls for tax deductions or credits to people who are caregivers in order to encourage them to continue their efforts; initiatives to support the development of home equity programs, such as reverse mortgages, to finance long-term care services; policy changes to address Medicaid’s current bias toward placing the elderly and persons with disabilities in nursing homes; and better public education about the importance of individual planning for long-term care needs.

Not all the commission’s recommendations are likely to be warmly received in the new Democratic Congress.

Rep. John D. Dingell (D-MI), who will be the new chairman of the Energy and Commerce Committee, dismissed the study panel as "a hand-picked commission stacked against working families." Incoming Senate Finance Committee Chair Max Baucus (D-MT) said that many of the commission’s proposals would make it more difficult for "the most vulnerable Americans" to get comprehensive care.