Virginia, Nevada, Louisiana, Arkansas Continue Medicaid Cut Struggles

Another set of massive budget cuts by the House

Another set of massive budget cuts were proposed today, this time by the House of Delegates to close Virginia’s $4 billion shortfall.

And a lot of it will sound familiar.

The reason: the House plan is largely in line with the cuts proposed by Governor Bob McDonnell.

The major differences are:

The house plan rejects McDonnell’s suggestion of 10 furlough days over two years for most state workers, it spares further cuts to higher ed, it kills a proposed out-of-pocket employee retirement contribution, and it provides a 2011 Christmas bonus.

For more, see http://www2.wsls.com/sls/news/local/article/another_set_of_massive_budget_cuts_by_the_house/82757/.

Nevada in Budget Squeeze

Nevada's $887 million deficit is puny compared with California's $20 billion hole.

But in a state that operates one of the leanest budgets in the nation, that amounts to a 22% shortfall, a gap that has some worried that the state might fall further behind in such areas as education and health care, where it already lags behind other states. Others sense an opening to chart a new course in small government.

"We are working on solutions to turn this recession into an opportunity to reinvent our state's government," Republican Gov. Jim Gibbons said in an emergency State of the State address this month. "We may never have an opportunity like this again," he said. Mr. Gibbons faces a tough primary battle this year and has had low approval ratings.

For more, see http://online.wsj.com/article/SB10001424052748703791504575079391267764362.html?mod=WSJ_latestheadlines#.

La. budget cuts outlined

Mid-article: Many agencies still will have to make do with less money in the upcoming budget year.

In health care:

• The more than $6 billion Medicaid program would get $350 million less than what was initially authorized in the current fiscal year.

The reduction translates into an average 3 percent cut in the reimbursement that doctors, hospitals and other Medicaid providers receive for treating the poor. The practical effect is that Medicaid program enrollees may have a tougher time finding someone to care for them.

State Health Secretary Alan Levine said he has not decided yet how to distribute the rate cuts. Some providers may get a larger percentage cut than others.

• In mental health services, the Jindal administration replaced only $30.9 million of a $42.9 million reduction in federal funding.

Levine said the administration wants to save money by caring for more of the mentally ill in the community rather than in institutions. He said institutions are more expensive than contracting for private beds in patients’ communities.

The state operates mental health institutions in Pineville, Jackson and Mandeville.

Levine characterized the shift as a reform rather than a reduction — a shift away from locking people in a mental hospital when they may not need that level of treatment.

However, the closure of beds in state institutions likely will mean a loss of jobs if workers cannot find employment with a private company or simply cannot relocate.

Levine said he is trying to prevent the reduction in federal money from causing a reduction in mental health services.

“Let’s catch our breath. Let’s try to make structural changes,” he said.

For more, see: http://www.2theadvocate.com/news/84877837.html.

Arkansas lawmakers fret over Medicaid budget cuts

Arkansas lawmakers on Tuesday told the state's Human Services chief they want more influence over how the state will reduce the cost of Medicaid programs by $400 million.

Arkansas Department of Human Services Director John Selig told lawmakers the department plans to keep next year's budget for the program at the same level as this year. But Selig says that means cutting $400 million in the program because of increasing costs and more clients.

For more, see: http://www.businessweek.com/ap/financialnews/D9DTFAUG0.htm

Medicaid State Budget Cuts in the New York Times

http://www.nytimes.com/2010/02/19/us/politics/19medicaid.html

February 19, 2010

States Consider Medicaid Cuts as Use Grows

By KEVIN SACK and ROBERT PEAR

WASHINGTON — Facing relentless fiscal pressure and exploding demand for government health care, virtually every state is making or considering substantial cuts in Medicaid, even as Democrats push to add 15 million people to the rolls.

Because they are temporarily barred from reducing eligibility, states have been left to cut “optional benefits,” like dental and vision care, and reduce payments to doctors and other health care providers.

In some states, governors are trying to avoid the deepest cuts by pushing for increases in tobacco taxes or new levies on hospitals and doctors, but many of those proposals are running into election-year trouble in conservative legislatures.

In Nevada, which faces an $881 million budget gap, Gov. Jim Gibbons, a Republican, proposed this month to end Medicaid coverage of adult day care, eyeglasses, hearing aids and dentures, and, for a savings of $829,304, to reduce the number of diapers provided monthly to incontinent adults (to 186 from 300).

“We are down to the ugly list of options,” the state’s director of health and human services, Mike Willden, told a legislative committee last week.

The Medicaid program already pays doctors and hospitals at levels well below those of Medicare and private insurance, and often below actual costs. Large numbers of doctors, therefore, do not accept Medicaid patients, and cuts may further discourage participation in the program, which primarily serves low-income children, disabled adults and nursing home residents.

In Kansas, a 10 percent cut in provider payments that took effect on Jan. 1 has prompted such an outcry that Gov. Mark Parkinson, who imposed it, now wants to restore the money by raising tobacco and sales taxes.

Even if Mr. Parkinson, a Democrat, overcomes resistance in his Republican-controlled Legislature, it will be too late for Dr. C. Joseph Beck, a Wichita ophthalmologist who informed his Medicaid patients last month that he could no longer afford to treat them.

Dr. Beck said that over eight months last year, his practice wrote off $36,000 in losses from treating 17 Medicaid patients. The state-imposed payment cut, he said, was “the final straw.”
“I’m out, I’m done,” Dr. Beck said in a telephone interview. “I didn’t want to. I want to take care of people. But I also have three children and many employees to take care of.”

Concerns about health care costs are likely to dominate the winter meeting of the National Governors Association, which begins Saturday in Washington.

In advance of the gathering, administration officials have urged governors to endorse President Obama’s health care proposals, or at least to avoid criticizing them. The Democratic plan, which is stalled in Congress, would vastly expand eligibility for Medicaid as one means of reducing the number of uninsured.

But many governors said they were more concerned about the growth of existing health programs. The recession and high unemployment have driven up enrollment in Medicaid while depleting state revenues that help pay for it.

A survey released Thursday by the Kaiser Family Foundation found a record one-year increase in Medicaid enrollment of 3.3 million from June 2008 to June 2009, a period when the unemployment rate rose by 4 percentage points. Total enrollment jumped 7.5 percent, to 46.9 million, and 13 states had double-digit increases.

Because Medicaid enrollment often lags behind unemployment, this year’s increase could prove even greater.

The National Association of State Medicaid Directors estimates that state budget shortfalls in the coming fiscal year, which begins in July in most states, will total $140 billion. Because Medicaid is one of the largest expenditures in every state budget, and one of the fastest-growing, it makes an unavoidable target.

“For most states, the fiscal situation is still dire, and the Medicaid cuts are significant,” said Scott D. Pattison, executive director of the National Association of State Budget Officers.

Governors and legislators have managed to defer the deepest cuts because the federal stimulus package provided $87 billion to states in Medicaid relief. The cost of Medicaid is shared by the federal and state governments, with states setting eligibility, benefit and reimbursement levels within broad federal guidelines, and Washington covering the majority of the expense.

But the stimulus assistance is due to expire at the end of December, in the middle of many states’ fiscal years, leaving budget officials to peer over a precipice. Congress and the White House are considering extending the enhanced payments for six more months, at a cost of about $25 billion.

The House has passed such a measure and Mr. Obama included it in his budget this month, but the Senate has not acted.

The extension would not come close to filling the Medicaid gap in many states. In Georgia, for instance, Gov. Sonny Perdue assumed in his budget proposal that the additional federal money would be provided, but that the state would still face a Medicaid imbalance of $608 million, said Dr. Rhonda M. Medows, the commissioner of community health.

Mr. Perdue, a Republican, decided it would be unwise to cut optional benefits because that might drive Medicaid patients into expensive emergency rooms. He proposed instead to levy a 1.6 percent tax on hospital and managed care revenues and to cut payments to many providers by nearly 2 percent.

Without the tax increases, which face opposition in the General Assembly, the state will have to cut provider payments by 16.5 percent, Dr. Medows said.

“I won’t have any primary care doctors left, much less specialists,” she said. “Certainly down here nobody likes to talk about taxes, but sometimes you have to bite the bullet and do what’s right for a whole lot of people.”

In the Kaiser survey, almost every state reported that Medicaid enrollment for the current fiscal year was exceeding expectations, making midyear budget cuts necessary.

The options are limited by several realities. To qualify for Medicaid dollars provided in the stimulus package, states agreed not to tighten eligibility for low-income people. And any time a state cuts spending on Medicaid, it loses at least that much in federal matching money.

Despite the ban on restricting eligibility, hard-hit states like California and Arizona are considering proposals by their governors that would remove hundreds of thousands from the rolls once the federal financing ends. Gov. Jan Brewer of Arizona, a Republican, has called for eliminating Medicaid coverage for 310,000 childless adults and ending the Children’s Health Insurance Program to help close a two-year budget gap of about $4.5 billion.

Gov. Phil Bredesen of Tennessee, a Democrat, is proposing the largest cuts in the history of TennCare, his state’s Medicaid program. To trim 9 percent of the TennCare budget, he would establish a $10,000 cap on inpatient hospital services for nonpregnant adults and would limit coverage of X-rays, laboratory services and doctor’s office visits.

“I have no choice,” Mr. Bredesen said.

Nevada, Pennsylvania, Virginia Updates

Passed on by Bob Williams:

February 10, 2010 – That’s The Way It Is: (Feel free to repost in full or in part)

PUBLIC OBSCENITY IN NEVADA: Former U.S. Supreme Court Chief Justice Warren Burger said that people know obscenity when they see it. The same is true of obscene public policy. Arguing that the state could no longer afford to pay for "bloated government services", Nevada Governor Jim Gibbons has proposed to cut 109 million in state Medicaid funding. According to news reports, such cuts would results in the “ration(ing of) adult diapers, eliminate denture and hearing-aid programs, and force personal care assistants to buy their own disposable gloves” as well as reduce services for persons with traumatic brain injury. "Cutting them off of dentures, hearing-aid services and diapers, “Assembly Speaker Barbara Buckley, D-Las Vegas, commented, “I don't know how we look the elderly in the eye." Not only would these cut degrade the civil rights and essential humanity of Nevadans with disabilities, their families and personal assistants but also expose them to potential health risks as well. See: http://journalstar.com/news/national/article_5743704b-b9ec-5b22-9b5a-88f00b0cca8f.html.

A FRIEND IN PENNSYLVANIA: When most other States are slashing Medicaid funding for community living, Pennsylvania Governor Ed Rendell says he wants to invest in making “major progress rebalancing and restructuring the long-term living system to ensure that older Pennsylvanians can age in place at home with dignity and a high quality of care.” The Governor’s 2010-11 budget includes a $17.3 million increase for direct services. “Over the last eight years, funding for aging and long-term living services has grown by $1 billion, a 307-percent increase. “ According to a release from his office, “Nursing homes will be eligible for $24 million more to support the increased needs of a more complex nursing home population. In addition, nearly 1,700 additional older adults and 1,525 additional persons with disabilities will be able to receive home- and community-based services so that they can live more independently. Finally, 4,000 additional older Pennsylvanians will be able to get their prescription drugs through the PACE and PACENET programs.The gains for older Pennsylvanians and persons with disabilities would not have been sustainable without major initiatives to rebalance the long-term living system. The share of consumers served in their home has doubled since 2003. Because home-based services are more cost-effective, scarce public resources can be stretched further.”” See: http://www.prnewswire.com/news-releases/governor-rendell--2010-11-budget-preserves-health-care-for-seniors-persons-with-disabilities-and-pennsylvanias-poorest-families-83890992.html.

LIFE DEFERRED: When Sam May graduates from a Fairfax Virginia high school next year, he should be able to look forward to his life – finding a job, attending community development, making plans to move into their own home someday. Instead, May, who has significant disabilities due to Fragile X syndrome, will have his life and future put on indefinite hold by being placed on a waiting list along with over 600 others with intellectual and developmental disabilities. At least half of these persons have been deemed by the county to have an “urgent need” for such Medicaid waiver services as personal assistance, supported employment and other supports to remain in their homes and communities. In 2007, Virginia agreed to put more resources into increasing accessing to these services and supports and to fall the waiting list. However, impending budget cuts threatens to make an already precarious and dire situation even worse. See: http://www.fairfaxtimes.com/cms/story.php?id=1049.