Clip files / Local news from the states
This column features selected short items about state health care policy.
Medicaid shortfalls plague Illinois
SPRINGFIELD, IL—Gov. Rod Blagojevich’s administration says it has stopped the fiscal bleeding in the government medical insurance program for poor people. But hospitals, doctors, and nursing homes that serve Medicaid recipients insist they still are feeling the pain. Dr. Russell Brown, the president of Logan Primary Care Center in Herrin, IL, said the financial squeeze on the eight doctors and four physician assistants in his clinic could end Medicaid services there. Brown said other doctors in Southern Illinois already have excluded patients covered by Medicaid. As a result, his rural clinic, which receives 20% of its business from Medicaid patients, is seeing more Medicaid recipients.
"These people are losing their ability to go to physicians," he said.
Thanks to a short-term state loan, the state and federal governments infused $1.3 billion to $1.5 billion into the system in late May. That meant a $100,000 check for Logan Primary Care. But since then, the clinic’s past-due Medicaid bills have ballooned to more than $167,000, Mr. Brown said.
Mr. Blagojevich, who took office in January, has repeatedly said he would protect spending on health care — along with public safety and public schools — from the ravages of a down budget year. Andrew Kane, the deputy administrator in medical programs for the Illinois Department of Public Aid, said Blagojevich has made good on that promise by signing a budget that prevents Medicaid’s deficit from expanding. That will keep payments to Medicaid providers from getting any later than they already are, he said. On average, Mr. Kane said, Medicaid bills are paid to providers 55 days after the Department of Public Aid receives them.
"We have stabilized payment cycles by equalizing the appropriation with the liability. So [Blagojevich] goes a very long way toward addressing the underfunding," he said. "It stops the bleeding."
—Quad City Times, Davenport, IA, July 13
Medicaid to cut dental benefits for WA adults
OLYMPIA, WA—Washington will pare back adult dental coverage for Medicaid patients next month in a bid to save $22.8 million over the next two years in part by eliminating payments for overused dental procedures. That means low-income Medicaid adults will lose coverage for crowns, back-teeth root canals, and several other dental services starting Aug. 1. Children on Medicaid are not affected. The coverage changes were prompted by the new, tighter state budget. Washington was expecting to have to pay out $88.7 million in dental coverage for Medicaid adults over two years. That budget has been cut by 26% to $65.9 million. The revised dental plan preserves coverage for preventive services such as checkups and gum-disease treatments. It also keeps insurance for partial dentures and limited replacement dentures, which initially were slated for cuts. But the state will stop covering crowns, or caps that are used on teeth that no longer can take a filling. The procedure, which costs about $300 per tooth, is among those that have been "overused" by dentists who treat Medicaid patients, said John Davis, a dentist and a consultant to the state’s Medicaid Assistance Administration, which oversees the Medicaid program. Tooth bonding, which is cheaper than crowns, will still be covered.
— Seattle Times, July 11
Medicaid may force elderly to sell homes
FRANKFORT, KY—Many elderly residents of nursing homes will be forced to sell their houses to help pay for their care under changes state Medicaid officials plan to implement Sept. 1. And the state will no longer allow heirs a "homestead exemption’’ of $50,500 when it seeks to recover its costs from estates of nursing home residents who have died, says state Health Services secretary Marcia Morgan.
The state also will become much more aggressive in trying to recover its costs from estates of deceased nursing home residents, she says. Those steps are among several Ms. Morgan and state Medicaid Commissioner Mike Robinson outlined recently as part of a continuing effort to reduce a multimillion-dollar deficit in the federal-state health plan for the poor and elderly in nursing homes. The measures would save the state about $18 million in the fiscal year that began July 1 with increased savings in future years.
Kentucky currently has about 17,000 people in nursing homes. About 75% of them are covered by Medicaid. Ms. Morgan acknowledged the new steps are likely to be controversial with the public and with lawmakers. "But we have no good alternatives at this point,’’ she said.
—Louisville Courier-Journal, July 10
Doctors applaud repeal of Medicaid pay cuts
LAS VEGAS—Sick, poor Nevada children should get their doctors back after state Medicaid officials rescinded recent pay cuts to pediatric specialists. The move to increase reimbursement rates came after at least 25 specialty physicians stopped taking Medicaid patients in May, forcing at least one family out of state for care.
The rates will return to approximately what they were before the state cut them, said Charles Duarte, administrator for the Nevada State Division of Health Care Financing and Policy.
The rate increases will be retroactive to May 8, when the reimbursement rates were first slashed. The money to increase rates will have to come from some other Medicaid program, although it’s unclear yet which program will face cuts, Mr. Duarte said. "It should just be a matter of days before the claims will be automatically processed at the revised rates," he said.
"Overall, doctors will be getting paid the same as they did before, but procedure to procedure, reimbursement rates will be a bit different," Mr. Duarte explained.
The rate increases will affect doctors who perform surgical or radiologic procedures on patients under age 21. Many pediatric specialists who stopped taking Medicaid patients in May say they’ll start seeing new patients again under the revised rates.
Those physicians said the reductions in rates, in some instances by as much as 80%, made caring for Medicaid patients unaffordable. They also said the large reductions in payment didn’t give them adequate income to pay their office overhead and remain in business.
— Las Vegas Review-Journal, July 15
1,800 could lose Medicaid benefits
LEXINGTON, KY—Nearly 1,800 Kentuckians are in danger of losing Medicaid services under state cost-cutting measures, according to Medicaid records through the end of June. The cuts are intended to ameliorate a $450 million Medicaid budget deficit for this fiscal year. They’re based on the assumption that people affected by them would be able to afford care on their own. Those who have lost coverage under the federal-state health plan for the poor include about 216 people seeking nursing home care. But the rest, 1,566 people, are those seeking assistance in the home or community because of illness or disability. That number includes older Kentuckians, the mentally disabled, and emotionally disturbed or autistic children receiving therapy through Medicaid. Earlier this year, the state eliminated the "personal care" category of Medicaid service intended for recipients not seriously ill or disabled and not in need of intensive nursing care. Now, the state is reviewing its Medicaid recipients and applicants with an eye toward cutting some off under the new rules to keep the program running. "We have consistently said there would be consequences," state Health Services secretary Marcia Morgan said. "We very much believe we ought to cover those most in need and those most vulnerable, and there are no good choices left."
—Lexington Herald-Leader, July 21
Medicaid coverage for 10,000 in state is back on hold
LINCOLN, NE—Despite a federal court decision, low-income parents in Nebraska who lost Medicaid benefits during the past year because of budget-cutting decisions will not have their medical services reinstated immediately. The Nebraska Health and Human Services System (HHSS) has asked the federal court to reconsider its decision that Nebraska likely illegally ended Medicaid services for more than 10,000 Nebraskans, generally low-income working mothers. The state’s request effectively delays the court’s temporary injunction requiring HHSS to reinstate the cut-off Medicaid recipients. Attorneys for the plaintiffs will seek a quick dismissal of the state’s petition, arguing that the likelihood for the state to get a rehearing is extremely low.
— Lincoln Journal/Star, July 18
Medicaid shortfalls plague Illinois; Medicaid to cut dental benefits for WA adults; Medicaid may force elderly to sell homes; Doctors applaud repeal of Medicaid pay cuts; 1,800 could lose Medicaid benefits; Medicaid coverage for 10,000 in state is back on hold
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