This column features selected short items about state health care policy.

Medicaid plan would restrict nursing homes to truly poor

ALBANY, NY—Leaders of the New York State Senate have proposed far-reaching revisions of Medicaid, the health plan for the poor that has become a crippling burden on New York’s state and local governments. They recommended, among other things, the diversion of people from nursing homes and restrictions on access to some prescription drugs. The Senate Republicans said their plan would both improve care and save $2.5 billion over five years, claims that were made difficult to gauge by a lack of detail in their report.

Democrats and a variety of liberal groups quickly disputed such predictions, but some of the Senate’s usual critics, particularly advocates for the disabled, held out cautious hope that this time, the Republicans were on to something valuable. Majority Leader Joseph L. Bruno and his colleagues are taking on the $40 billion-a-year program because of the strain it puts on state finances, and discontent at the local level that many state lawmakers fear could grow into a political backlash against them. The counties and New York City pay a share of the program’s cost, an expense that has expanded even as their budgets have contracted, prompting local officials to complain that Medicaid has forced them to cut other programs and raise taxes.

—New York Times, Dec. 23, 2003

Nebraska unveils mental health plan

LINCOLN, NE—Hastings and Norfolk officials say they’re uneasy about the newly unveiled proposal for a state mental health facility in Omaha. It’s not that they dispute Omaha’s crying need for more crisis care and intermediate care. But they fear that the Omaha facility is the reason that the state mental hospitals in their communities have been targeted for closure. "I’d like them to have a good facility there, one that’s functional, accessible, and meets the needs of patients," said Kevin Piske, a psychologist at the Norfolk Regional Center. "I don’t want to see them cannibalize Norfolk and Hastings for a facility that really isn’t going to do anything different," he said.

Gov. Mike Johanns and officials at the University of Nebraska Medical Center and Creighton University Medical Center presented a document describing a Nebraska Center of Excellence in Behavior Health they envision for Omaha. The two medical centers would provide staff for the facility. Construction and start-up costs would be paid through private donations, Mr. Johanns said. Ongoing operational costs would come from government coffers. It is the latest piece of the state’s mental health overhaul — proposed by the governor and state Sen. Jim Jensen of Omaha — that calls for the closure of regional centers in Norfolk and Hastings in 2005 to free up and bring in money for community-based mental health services.

—Omaha World-Herald, Dec. 16, 2003