Clip files / Local news from the states
This column features selected short items about state health care policy.
Legal drug-runners fill Medicaid gaps
GRAND COULEE, WA—Keith Houtz walks out of a pharmacy, his arms full of other people’s drugs. He’s a legal drug-runner on a mission of mercy — a seven-hour drive through Okanogan, WA, orchards to deliver painkillers, insulin, and anti-depressants to Medicaid patients whose pharmacies cut them off. "I like to visit folks," said Houtz, his cowboy boots light on the gas pedal as he heads out on a searing recent day. "And they’re happy I bring the supplies. That makes me feel neat." The folks he visits are caught between indignant pharmacists and Washington state Medicaid managers.
Lawmakers slashed $22 million from pharmacists’ reimbursements last session in a bid to reduce a deficit that still rang in at $1.6 billion. Medicaid officials suggested the cut, believing pharmacies would keep serving the state’s 500,000 Medicaid patients. They didn’t. On Aug. 1, all but one of the nine pharmacies in Okanogan County cut off Medicaid clients, citing concerns about solvency. That left many of the 4,630 county residents on Medicaid 100 miles from a pharmacist willing to serve them.
The same story is playing out in rural counties statewide, Medicaid officials concede. No pharmacy in Pacific County will accept Medicaid, and at least a half dozen backed out in Yakima. So the state Department of Social and Health Services (DSHS), which manages Medicaid, has come up with a stopgap solution: Houtz and other members of its fleet of "transportation brokers," who until now have mostly shuttled rural Medicaid patients to dialysis for 34.5 cents a mile. With hundreds of drivers making such runs, the $40 million DSHS allocated for contracted transportation brokers may not last long.
"The state is being penny-wise and pound-foolish," said David Sclar, a pharmacoeconomist in Washington State University’s College of Pharmacy. He predicts rising costs elsewhere in the Medicaid program. "Pharmacies are one thing we pay for that saves us from more expensive doctor visits, hospital visits. . . . DSHS is looking at pharmacy reimbursements in isolation and not on what this will cost on a system level."
—Associated Press, Aug. 19
Lawsuit plans ridiculous,’ says Medicare director
DES MOINES, IA—Medicare’s top administrator have lashed out at Iowa’s governor and attorney general, saying a planned legal challenge to his agency’s treatment of the state is ridiculous and absurdly irresponsible. "They’re kidding themselves — and if they actually claim to have good legal guidance, they’re crazy," said Tom Scully, the head of Medicare and Medicaid Services. Gov. Tom Vilsack and Attorney General Tom Miller have said that they planned a formal appeal of Medicare formulas that they say are shortchanging the state hundreds of millions of dollars. They said Mr. Scully’s agency is failing to follow a clause, written by Congress, requiring that states be treated with "actuarial equivalence." The controversy centers on complicated financial calculations that favor more populous states. Iowa ranks near the bottom on many measures of spending by Medicare, the giant health-insurance program for the elderly. Critics say the situation has led to a $1 billion annual shortfall that is crippling the state’s health care system.
Mr. Scully said he and his boss, Health and Human Services Secretary Tommy Thompson, are sympathetic to the plight of Iowa and other small states. "We’ve bent over backwards trying to help," he said. In fact, Mr. Scully said, the department has been taking criticism from urban states for those steps. The law prevents them from doing more, he said, and if Iowans want improvements, they should look to Congress, not the courts.
—Des Moines Register, Aug. 21
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.