[Marxism] States Cut Medicaid Coverage Further

[Greg McDonald <sabocat59@xxxxxxx>]

States Cut Medicaid Coverage Further
Region Is Among Areas Where Poor Are Affected
        
By Amy Goldstein
Washington Post Staff Writer
Friday, December 26, 2008; Page A01

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.
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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.

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.

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.


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