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State cuts to Medicaid affect patients, providers
ATLANTA (AP) — Just as Medicaid prepares for a vast expansion under the federal health care overhaul, the 47-year-old entitlement program for the poor is under increasing pressure as deficit-burdened states chip away at benefits and cut payments to doctors.
Nearly every state has proposed or implemented a plan in its current budget to rein in costs, and many are considering additional cuts in the year ahead.
For the tens of millions of poor and disabled who rely on the program — approaching nearly one in five Americans — the cuts translate into longer waits for doctors, restrictions on prescription drugs, a halt to vision and dental care, staff cuts at nursing homes and dwindling access to home health care.
Ruth Wohlforth, 70, is among those feeling the effects.
Her $700 monthly income qualifies her for both Medicare and Medicaid, but she says her benefits have been reduced, she’s being forced to make co-payments for the first time on prescription drugs, and she now has to drive about 30 minutes from her home near the southern tip of New Jersey to see a doctor. Some of her friends have been assigned to doctors in Philadelphia.
She said she feels lawmakers are not aware of the real-world consequences of their spending cuts.
“I’ve seen so many people in tears, and they don’t know what to do,” Ms. Wohlforth said. “People that are older than I am and are in worse shape, they get befuddled by the whole thing. They don’t know where to go for help; they just feel they’re not being listened to.”
States are reshaping the Medicaid landscape even as the need has grown along with joblessness during the recession.
The $427 billion-a-year program, a combination of state and federal funding, also was targeted for additional cuts at the federal level this year as members of Congress sparred over how to reduce the nation’s debt. But funding seems safe for now after a special committee failed last month to reach an agreement on how to cut overall spending.
Already, many changes at the state level have been dramatic and are testing the legal bounds of what Medicaid must provide:
• Arizona, for a time, eliminated life-saving transplants for Medicaid patients, and hospital officials in the state blame at least one death on the halt in coverage. Gov. Jan Brewer restored transplants but is prohibiting thousands of low-income, childless adults from entering the program and has added fees on those who smoke and the obese.
• New Jersey Gov. Chris Christie is pushing a plan under which only the poorest would qualify. A parent of two making more than $103 per week would no longer be eligible for coverage.
• The U.S. Supreme Court will decide whether California has the right to continue cutting payments to physicians and other Medicaid providers to help close the state’s ongoing budget deficit.
Cuts to provider fees, as in California, have been the most frequently used tactic by states to save Medicaid costs. A recent survey by the National Association of State Budget Officers found that 33 states wanted to reduce provider rates and another 16 sought to freeze them.
California was granted permission by federal officials to make broad cuts to reimbursement rates to its Medicaid program, known as Medi-Cal, in October. The cuts include a 10 percent reduction to payments for outpatient services for doctors, clinics, optometrists, dental services, medical equipment and pharmacies. They are intended to save the state an estimated $623 million.
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