States Cut Medicaid Coverage Further

Washington D.C. Region Is One Where The Poor Are Hit The Hardest

(Washington Post)  States from Rhode Island to California are being forced to curtail Medicaid, the government health insurance program for the poor, as they struggle to cope with the deteriorating economy.

With revenue falling at the same time that more people are losing their jobs and private health coverage, states already have pared their programs and many are looking at deeper cuts for the coming year. Already, 19 states -- including Maryland and Virginia -- and the District of Columbia have lowered payments to hospitals and nursing homes, eliminated coverage for some treatments, and forced some recipients out of the insurance program completely.

Many are halting payments for health-care services not required by the federal government, such as physical therapy, eyeglasses, hearing aids and hospice care. A few states are requiring poor patients to chip in more toward their care.

"It's not a pretty list at all," said Michael Hales, Medicaid director in Utah.

Medicaid, a central piece of the Great Society safety net created in the 1960s, is the nation's largest source of government health insurance. It covered 50 million Americans last year. The program is a shared responsibility of the federal government and the states, with federal money paying an average of 57 percent of the bills and states providing the rest.

Federal health officials set minimum rules about who can enroll and what care must be covered, but states are free to add to the basics. Those optional patients and services are what many states are rethinking now.

With the program the largest or second-largest expense in every state's budget, governors and state legislators have been pleading with Congress and the incoming Obama administration for help. The Democrats, who hold majorities in the House and the Senate, are sounding sympathetic for now. They are considering close to $100 billion to increase the share of Medicaid's costs that the federal government would pay during the next two years.

President-elect Barack Obama also is open to extra help for Medicaid as part of a broad strategy to spur the economy. "We are considering a number of proposals . . . including helping states meet Medicaid needs; reducing health-care costs; rebuilding our crumbling roads, bridges and schools; and ensuring that more families can stay in their homes," said Nick Shapiro, an Obama transition spokesman.

According to a Washington source who is in close contact with lawmakers, some in Congress also are beginning to entertain the idea of allowing unemployed people who have lost health benefits to sign up for Medicaid, with federal money paying the entire bill.

In the meantime, uncertainty over how much help may come, and when it might arrive, is prompting many states to make the biggest reductions to their Medicaid programs in years -- and in some cases, ever.

Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured, said the pressure on Medicaid programs is particularly acute because the economy has deteriorated so soon after a milder recession early in the decade. States already "have taken the cuts that were making the program more efficient. . . . Now they are making . . . cuts into the core," she said.

Nineteen states and the District have cut Medicaid for the current fiscal year, according to a survey this month by Families USA, a liberal consumer health lobby. All but one, plus six other states, are drafting deeper reductions for the coming fiscal year that they hope to avoid. Florida's Medicaid officials have just handed the governor and legislature a blueprint for a 10 percent reduction; it would eliminate coverage for 7,800 18- and 19-year-olds and 6,800 pregnant women.

Among the states with the gravest financial problems -- and pressures on Medicaid -- is California. In July, Medi-Cal, as the program there is known, slashed by 10 percent the rates it pays hospitals, nursing homes, speech pathologists and other providers of health care. It tried to lower payments to doctors and dentists, too, but they have sued to block the decreases.

Gov. Arnold Schwarzenegger (R) has asked the state legislature to approve other cuts, including an end to dental care for adults, about 1 million of whom use it now, and a sharp reduction in care for recent immigrants.

At two hospitals run by NorthBay Healthcare, midway between San Francisco and Sacramento, about one patient in five is on Medi-Cal. The rate cuts translate into a $4 million loss this year. In September, the health system closed a rehabilitation program for children that provided physical therapy, speech therapy and other help to about 300 young patients at a time - with 100 more usually on the waiting list.

"It was heart-wrenching to have to go out and announce," said Steve Huddleston, NorthBay's vice president of public affairs.

The strain has spread through the Washington area. The District's Medicaid rolls have risen by 5,000 in the past year to nearly 150,000. To cope, the District made $20 million worth of changes to the program and a separate fund for people who are uninsured, including postponing an increase in payments to primary-care doctors.

In Maryland, Medicaid enrollment has jumped by 8 percent in the past year, and the state has pared $82 million from the program for this year, reducing planned increases in payments to nursing homes, managed-care organizations, private nurses and home health aides. With a larger state deficit forecast for next year, Gov. Martin O'Malley (D) is expected to propose deeper cuts in his budget next month, probably including a lengthy delay of the state's biggest Medicaid expansion in years: a planned extension of coverage to 100,000 parents and other adults.

In October, Virginia eliminated a small fund for indigent patients. For the coming year, Gov. Timothy M. Kaine (D) has just proposed $245 million in cuts from the nearly $3.3 billion that the commonwealth devotes to Medicaid, including reduced payments to hospitals and new limits on home health care.

Rhode Island's approach has been the most far-reaching to date. This week, it announced an agreement with U.S. health officials that would, if the state legislature consents, change the entire financial basis of the program. The state would forfeit its Medicaid entitlement and accept a total of $12 billion in federal money over the next five years. In exchange, Rhode Island would win uncommon freedom from federal rules, allowing it to enroll all its Medicaid patients in managed care, cover less treatment and expand care for elderly patients at home, instead of in more-expensive nursing homes.

In South Carolina, Medicaid officials last week announced the third round of cuts since August. They are "real unpleasant stuff," said Jeff Stensland, spokesman for the state's Department of Health and Human Services. The program will stop paying for most dental care for adults, eliminate nutritional supplements, cut home-delivered meals from 14 a week to seven, curtail mental health counseling, stop building wheelchair ramps and pay for fewer breast and cervical cancer screenings.

Edna McClain, founder of Hospice Care of Tri-County in Columbia, S.C., helped coax state health officials to expand Medicaid to cover nursing care and other support for dying patients in the mid-1990s.

She was stunned this month when an e-mail arrived from South Carolina's Department of Health and Human Services informing her that as of Jan. 1, Medicaid no longer would pay for new hospice patients. And after March 31, it would stop covering most people on Medicaid already in hospice care.

With a $500,000 hole in her budget, she worries about how to care for low-income hospice patients, including a 47-year-old man whose weakened body is dangerously retaining fluid as he awaits a liver transplant.

The day after she received notice from the state, McClain composed a letter and fired it off to 107 state legislators. "They can at least hear from me," she said. But she knows, she said, her protest is too late to make a difference.

Staff writers Chris L. Jenkins, Lisa Rein and Nikita Stewart contributed to this report.

[whitemale08]

Just another example of the austerity that happens when Adam Smith and his free hand ruins the economy once the ''free-market-capitalists'' loot everything.

Wall Street/City of London made it a life and death issue to receive their bailouts but when it comes to helping out the people who are sick,

it''s time to pull out the junkyard dogs like Rush Limbaugh and Sean Hannity to scream "We don''t have the money".

Truth is, ''globalization'' has been a disaster for our economy and this whole idea that private-central-bankers should stipulate ''budgets'' to allocate funds is stupid.

Where do you think these bankers are going to recommend to allocate funds for first?

Of course for Wall Street corporations to stimulate borrow/spending. And as soon as the economy implodes the first one the government is supposed rescue is the private-central-bankers.

Thanks Adam Smith, your system of ''free-market-capitalism'' is the best we can do.

[babooph]

Just part of the vision thing-the"new world order"-with the building of Asian middle classes,US can now "develop" into a third world nation -cancelling of the bill of rights -the POLICE state part is already complete.

[generey]

But we keep sending MILLIONS to other countries "to help their people".

[klingon69]

Relax, Cletis, it''''s not going to be quiet that bad. Study the ''''Great Depression''''. That''''s what we''''re headed for... not civil war. Things will eventually come around with new leadership.

If all you idiots had not voted Dubya a second term it would never have come to this.
Posted by nowaymcgoo at 07:08 PM : Dec 26, 2008

Mabny atrocities were committed during the Great Depression. What helped most people, was that family was close by. Most people lived nd died within 50 miles of birth. You had brothers, sisters, patents...etc nearby that could help you.

Not today. Plus neighbors don''t really exist anymore.

[wl7bzh]

Does anybody remember the movie "Soylent Green"?


Open ended question

Posted by wl7bzh at 07:24 PM : Dec 26, 2008

Yes, I have a few nominations for cookies some would be chocolate.

Posted by d7767w at 02:56 PM : Dec 27, 2008

Would the cookies happen to be full of nutz? If so, I think I know the source.

[payasyougo]

"States Cut Medicaid Coverage Further
Washington D.C. Region Is One Where The Poor Are Hit The Hardest"
----

Well, you don''t expect that the government should have to cut staffing or some other ridiculous cost saving measure do you? It''s not like they are accountable to anyone?

[elpaulito]

To all of you right wing nuts, don''t you people think it is time that the american people get something from the govt that we give our hard earned taxes to? Did we get $700bill in tax money to people who are being evicted from their homes? Nope. The suits got it, and quickly distributed it to eachother in the form of bonuses for doing such a great job.

You people are nothing more than kool-aid drinkers. "Oh yeah, supporting health care for low income children would be socialist, but, dropping $700bil on a wall st bailout is super duper. U-S-A-U-S-A.... Thyrow on that there nascar". Gimme a break. We are already trailing the vast majority of the developed world in the populations health. You idiots keep thinking that the ghost of reagan is going to come back, and somehow everything will be wonderful. The truth is, is that capitalism has done nothing for american healthcare except make it more expensive. You have the nerve to bash on europeans for having accessible healthcare for all. Well, when you lose your jobs, have a heart attack, and need care, dont come looking to me for a handout. I will kick you and continue walking.

[drivelphobe]

comeon11..

You need to take your meds.

[longtree-2009]

medicare, medicaid, medical and so on. fraud committed by those in medicine with fraudulent billing by doctors, hospitals. recently a relative had to signup for medicare and was shocked to note that the monthly premium for A & B medicare were higher than any insurance premium he had ever paid while working. relative had to also signup for a senior plan with another insurance company further increasing his monthly premium. with the millions of retirees or people 65+ how is it that there is not a more reasonable plan premium? something not right about it and the continued fraud is not helping.

[comeon11]

RowdynTex......................shut up, Racist buffoon. you made no sense. we had the highest surplus under clinton. this nonsense took place after a billion dollars a day war. STOP BELIEVING THAT NONSENSE YOU WANT TO BELIEVE. IT ONLY EXIST IN YOUR MIND BECAUSE YOU WANT TO BELIEVE IT. IDIOT.

[wdh3007]

Yes coverage to illegals should cut off immediately but not just in California but across the nation. In theses tough economic times this will save money in the end to those who are U.S. citizens and work hard for it. It will also cut down on Illegal Immigration and I would even consider taking it a step further and deporting every illegal who crosses the border or who is already here and is somehow protected by the ACLU.

[tucson23]

There''s been way too much blame placed on the ''deteriorating economy'' for the lack of funds in state and local government. The fact is that Republicans have been starving the governments for money since 1980 with their refusal to tax anyone, especially those who can most afford it. Turns out that the poor need government services more than the rich, so what do they do? Stop taxing the rich so that governments can''t afford to help out the poor. And it''s not just welfare programs--your child''s education is getting short-changed by this same process, and you poor slobs are waiting in traffic for 2 hours a day because there''s no money to build roads. Republicans are fine with poor education, of course, as it guarantees a steady supply of cheap labor for the big corporations who don''t pay taxes. This is what you idiots have been voting for--the rich get richer and everyone else can go to h*ell.

[rudy6543]

Posted by drivelphobe at 10:46 PM

If there is a just God, your hands will get stuck to something freezing cold and you will remain there until summer.

[rudy6543]

How sad. Instead of government cutting back on unnecessary expenses like jet rides, retreats, per diems, paid vacations for themselves and their brats, or government projects that total billions, they decide its more important to cut back on medicine and education. A country that refuses to look after its own people will very much look like some third world disaster in the end.

[drivelphobe]

Physicians are suing to prevent the cutbacks, only because it decreases their revenues. 18 and 19 year olds should have to work and be ineligible for Medicaid. Pregnant women shouldn''t have offspring if they can''t afford to, so cut them off now. No more Medicaid to illegals. Why should the poor get free or subsidized dental care?

Our system is a joke. We hand out entitlements like they''re free and the money comes straight out of the pockets of hard-working, honest people who don''t make enough to pay for healthcare and dental coverage for themselves. Illegals just wander into an emergency room and get the best for free and laugh at how stupid the American citizens are.

These cutbacks are long overdue and no one should feel bad about delivering the news. The time has come to get what you can pay for.

California is in the worst shape because they have the most illegals, thank you Los Angeles and San Francisco, due to the sanctuary city status against the will of the people.

[zzy-izzy]

Bush is heading back to Texas with his gum-boots to see old dolly

[McHineguy]

The only people that need cut off are the stockholders. It''''s sad that if a person gets sick they have to worry about lining the pockets of stockholders as well. Most medical research occurs at Universities and is paid for through federal and state government grants. Then the medical industry looks for ways to monopolize on the research paid for by the taxpayers. The taxpayers then are charged for medications, devices, etc. for which they funded the research. Private Industry contributes just enough to tag the technology and call it their own. Had enough?? Socialize Healthcare, It''''s time we got what''''s best for us and not what''''s best for them.


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Posted by rightbehind at 07:33 PM : Dec 26, 2008

Many stock holders are charitable organizations, retirement funds, and churches.

[bjcone8559]

Glad you made it home. I was still a baby in 67.


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Posted by DebinOK1


Yeah... I''m getting old.

Now, back to the topic.

It''s OK if people are cautious, but broadcasting fear is not helpful. I came home from the war and got an education, now I am a political junkie. I believe in the United States of America. This is not the first test of our democracy. We will prevail. Remember, this is a government of, by and for the people. Our recent leaders have forgotten that, but I believe this new president understands. God bless.

[debinok1]

I had uncles over there. They all came back to Okie.

[debinok1]

Left in 1967... Vietnam.

Posted by nowaymcgoo
****************
Glad you made it home. I was still a baby in 67.