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Medicaid Watch:
State Medicaid and Health
Cuts & Expansions
By
Thomas P. McCormack [draft # 5, March 2, 2007;
Alabama---Has
no spend down; covers only 12 doctor visits & hospital
days yearly and 4 brand name Rx’s monthly (but unlimited generics);
and adopted ADAP cost containments;
but it again accepts SCHIP applications &
plans to raise doctor fees. The
risk pool offers no
low income premium discount & no Medicare supplement.
Alaska---this
Title XVI state has an aged/disabled income level of about 100%; has
no spend down; froze its nursing home income level;
cut the CHIP level from 200% to 175% (1,200 families lost children’s
coverage); tightened home care access rules;
has a risk pool with a
Medicare supplement but no
low income premium discount; and created a token SPAP that
Gov. Palin & the legislature (both R) favor, although it excludes
the disabled. There’s an ADAP waiting list.
A legislative study proposes
segregationally shifting Native Americans’ Medicaid services &
funding onto IHS/tribal health plans,
paying their added costs with 100% federal
matching from a Medicaid waiver the state would seek from CMS.
Arizona—has
no spend down & no
risk pool. A waiver covers all families under 200%
but only 100% for uninsured childless (and even
non-disabled) adults. The
legislature (R) raised parental premiums; but Gov. Napolitano (D)
called for more SCHIP enrollment with teachers’ help.
Arkansas---
Former Gov. Huckabee (R) got $100 million in higher tobacco & income
taxes to save the spend down, Katie Beckett waiver & adult vision
care and bolster nursing home rates.(but
other fees are still too low to attract enough providers). A
HIFA Medicaid waiver funds barebones,
subsidized insurance for
50,000 workers & spouses with incomes under 200% (also open to
30,000 “richer” families with a $100 monthly premium).
The state raised children’s dental fees to
95% of the private Delta Dental rates; seeks to now fund most
adult dental care; says its formulary saves $20
million yearly; it has a risk pool
that offers no low income premium discount & no
Medicare supplement. Gov. Beebe & the legislature (both D)
aim for more home-based & HCB care over nursing homes and more
health coverage expansion.
California---red tape & a lower income level have taken 200,000
parents off the rolls since 2004; and its
risk pool offers no
low income premium discount & no Medicare supplement.
Gov. Schwarzenegger (R) is forcing the aged & disabled into HMOs,
proposed a yearly patient dental care cap of $1,000,
made 5% doctor rate cuts; stopped
paying extra Medicare HMO premiums for dual eligibles; but will
raise SSP levels to $849 monthly ($1491/couple); spend $50 million
more to expand CHIP; start 500 health clinics in low income schools;
ban patient balance billing for ER visits; require prescription
discounts for the moderate income uninsured; and
proposed to
cover all uninsured children (even
illegals) under 300%, extend MediCal to all (even
childless, non-disabled) adults under 100% and subsidize insurance
for others under 250% (but illegal alien adults’ care
will stay county-funded), using DSH funds, already-available federal
matching and new provider “fees” on doctors (2%) & hospitals (4%)--
though not raising the aged/disabled income level up
to the new 250% subsidy level
(it’s now about 135%).
Hospitals, doctors & most GOP legislators
oppose the plan & see its “fees” as unfair taxes.
See
http://gov.ca.gov/index.php?/press-release/5057/ &
http://gov.ca.gov/pdf/press/Governors_HC_Proposal.pdf .His
health reform board aims to end mandated HMO coverage of
contraception, mental health care & cancer screening.
Colorado---has
no spend down; a court voided a law to deny benefits
to legal aliens & once-blocked CHIP applications are again
accepted. New referendum-voted cigarette taxes will raise the CHIP
level from 185% to 200% (covering 4,000 more children), open 600
more HCB and/or Katie Beckett waiver slots, boost funding for low
income clinics & raise the parents’ income level. The state is
shifting children into HMOs. Denver’s Medical Center & the Univ. of
Col. Hospital cut their indigent care & raised their co-pays; and
the state’s Indigent Care program for those not eligible for
Medicaid (e.g., the childless poor awaiting SSA disability
decisions), raised its co-pays: $10 per Rx, $35 per
doctor visit, $270 (!) per hospital stay & $15 to $45 per ER visit.
The state cut rates 15% to the ColoradoAccess HMO, so it then dumped
its 65,000 patients into fee-for-service Medicaid; but it
increased funding for its risk pool
(which still has no Medicare
supplement) to even further
discount premiums for low income patients; set up a board to
study coverage expansion; and ordered the Medicaid agency to adopt a
consumer-run board’s care plans for the disabled.
Gov. Ritter, bypassing the legislature
(both D), will adopt a formulary & join a multi-state drug buyers’
alliance with advice from a patient, pharmacist & doctor board; but
signed the legislature’s bill creating a drug discount plan for the
uninsured under 300%.
Connecticut—a
209(b) state; its risk pool has
a low income premium discount but
no Medicare supplement. Gov.Rell (R ) added doctor
co-pays of $1 to $3; upped SPAP premiums to $30 & its co-pays to
$16.25; imposed a $100,000 SPAP asset test; required recoveries of
SPAP costs from the deceased’s estates; dropped legal aliens
from TANF, Medicaid, CHIP & SAGA (state welfare & medical programs);
forced SAGA patients into HMOs; ended coverage of adult
chiropractor, naturopath, psychologist and occupational. physical &
speech therapy services; but dropped planned Rx co-pays as
uncollectible. The legislature (D)
raised the parents’ level back up to 150% is raising most pediatric
dental fees to 70% of private insurers’ rates for 2007; and offered
Medicaid to the working disabled & “recovered/ex-disabled”. Rell
proposed a $2 million disease management plan for high risk
patients; expanding SCHIP; requiring parents to insure children; and
subsidized barebones
insurance for uninsured adults—yet
offered no funding. Legislative
leaders countered with a $900 million plan to raise the Medicaid
level for all groups to 185%; cover all children;
otherwise subsidize coverage for lower income working families &
small firms; and raise the state’s hospital & individual provider
rates to the Medicare level.
Delaware---has
no spend down or risk pool;
but it covers all adults (even if not
parents or disabled) under 100%, yet caps yearly SPAP benefits. Gov.
Minner (D) & the split legislature (D Senate, R House) created a
Cancer Treatment Program for the uninsured not on Medicare under
650% (!) & a state indigent health program for the uninsured under
200%; raised the health budget; and
boosted provider fees to 65% of private insurance rates. Both
parties favor Minner’s proposal to cover the working disabled,
but funding it with a 45 cent tobacco tax
increase is opposed by the GOP House’s leadership.
District of
Columbia---has no risk pool
but a DC-funded Health Alliance covers all the uninsured
under 200% except Medicare,
Medicaid & SCHIP eligibles; Medicaid levels
are 200% for parents but only 100% for the
childless aged & disabled; and
the SCHIP level was just raised to 300%. A $240 million
health access plan backed by Mayor Fenty (D) boosts preventive
health & cancer screening; anti-smoking, ER & ambulance services;
and upgrades, expands & adds primary clinics. DC also increased its
home health & personal care aides’ pay; is hiring 75 parents as
preventive health counselors for school pupils; added coverage of
adult dental care; raised
all its dental fees; and will also
subsidize indigent dental care at Howard U. Dental School & low
income clinics. It raised its QMB & SLMB income levels up to 300%
FPL --not only making many more Medicare patients eligible for DC to
pay their Part A & B premiums & cost-sharing, but thereby also
for Part D’s full Extra Help. A DC
Council (D) bill offers HPV vaccinations to girls under 13
(DC’s cervical cancer rate is nearly double
the US rate). Yet the 2007 budget is short $87
million--mostly due to neglected eligibility workups (and thus
unclaimed matching) for CMI, MR & DD clients--which will rise to
$300 million thru 2008.
Florida---former Gov. Bush & the legislature (both R) outsourced
Medicaid, welfare & food stamp eligibility;
failed to adequately fund the risk
pool (it thus remains closed to new
patients, although it nominally
has a Medicare supplement
but no low income premium discount); and got a
waiver to privatize Medicaid & convert it, with premium support &
health savings accounts, into a “defined contribution” HMO-type
plan. The state cut the aged/disabled Medicaid income level
from $719 to $603 on 1/1/06 (77,000 lost coverage); set up a
Medicaid “reform” board; and abolished its SPAP 1/1/06. A
“fail first” rule allows costly mental health drugs only if cheaper
ones don’t work (with Lamictal, Paxil, Wellbutrin, Lexapro, Zoloft &
Zyprexa exempted). The state again covers adult dentures & hearing
aids and takes SCHIP applications year-round.
Provider & advocacy groups sued to raise
low fees for children’s care; made
the state drop a prior approval rule for nutrition supplements; and
objected to slow Medicaid prior approvals for flu vaccinations. Dade
County launched a $40 million plan for school nurses’ routine care &
to enroll students in Medicaid & SCHIP; and Gov. Crist (R) awarded a
$36 million contract to Pfizer for case management of 90,000
diabetics & other chronic disease cases.
Georgia---has
no risk pool & ended CHIP coverage of dental
surgery & other care and cut the Medicaid & WIC level for pregnant
women (7,500 lost coverage) & infants from 235% to 200%; raised CHIP
premiums; ended adult coverage of emergency dental care & artificial
limbs; is moving non-aged, non-disabled patients (including 200,000
on CHIP) into HMOs; ended spend downs for nursing home care (but
using certain trusts can still get or retain eligibility for some);
set up a 2nd insurance & Medicaid “reform” board; capped HCB
care costs; and tightened medical criteria for Katie Beckett waivers
(but some of the newly ineligible are covered by a foundation).
Gov. Perdue & the legislature (both R) plan
to cut nursing home access, raise co-pays & add more managed care &
health savings accounts to Medicaid; but offer the aged &
disabled disease management services.
The state ended 90 day coverage suspensions for children delinquent
in payment of CHIP premiums; but may bar
new CHIP applications due to uncertain federal funding. CMS
forbade use of the fiscal gimmicks that have brought in $300 million
extra yearly in federal funds & questioned $70 million in foster
children’s mental health costs. The rolls dropped 60,000 in 2006 due
to stricter eligibility re-determination & documentation rules.
Guam—this &
all other US territories’ Medicaid matching funds are
capped by law far below what states get. The local medically
indigent plan pays less than Medicaid & attracts fewer providers.
Managed care firms are seeking contracts that they say can save
enough to pay providers more. Funds for off-island specialty care,
and air transport to it, are exhausted.
Hawaii—a 209(b)
state with no risk pool;
a waiver covers parents & all uninsured adults not on
Medicare under 200%, (but
the childless aged & disabled must be under only 100%).
The state makes employers offer health coverage to employees &
dependents and created a token SPAP
for aged and disabled patients, but with a mere 100%
income level. Gov. Lingle (R) & the legislature (D) raised the child
& parent level to 250% (covering 29,000 more), lowered CHIP
premiums, restored some adult dental care through Medicaid & other
programs and expanded substance abuse care.
Idaho---a Title
XVI state, with no spend down &
no
risk pool. Former Gov. Kempthorne & the legislature (both R)
raised the CHIP level from 150% to 185% (with less benefits & more
co-pays for the added patients); funded a pilot
barebones health plan for 1,000
adults; covered the working disabled; cut state funds for medical
care for the temporarily disabled & those awaiting SSA disability
decisions; ended mandates for health insurance coverage of breast &
prostate cancer screening & mental health; and got CMS approval to
set up 3 patient classes: Parents & children (with $13 million less
a year and more cost-sharing & coverage cuts); the disabled &
chronically ill; and the aged. The first (but later the others) will
face more cost-sharing & there’ll be different (lesser) benefits for
each, with more preventive care & incentives.
Illinois---this
209(b) state’s main SPAP (funded as a Medicaid Pharmacy Plus waiver)
excludes the disabled, who get only a limited
formulary from a 2nd, separate SPAP. Gov. Blagjoievich &
the legislature (both D) added HIV drugs to the 2nd
SPAP’s formulary (for Medicare patients only); raised the parent
income level to 185%; agreed to a court order raising children’s
doctor, specialist & EPSDT rates (but fees
still remain too low to attract enough regular
providers); offered
subsidized insurance to veterans left uncovered by VA eligibility
cuts; and plan to offer a PCCM program, to
let anyone under 300% buy-in to Medicaid & to raise
its provider rates. The state risk pool,
with a largely closed waiting list,
has a Medicare supplement
but no low income premium
discount. A legislative health
reform board proposed Medicaid & SCHIP for parents & children under
200% (but still only 100% for
childless adults, including the aged & disabled);
and an insurance mandate for residents & employers, with low income
premium subsidies & tax incentives for small firms—costing the state
$3.5 billion & employers $1.5 billion. HMO enrollment is still
voluntary. Cook Co.’s hospital
system, serving the Chicago-area poor, faces a $150 million deficit
requiring service cuts, facility closures & denial of indigent
program eligibility to suburban county residents---caused partly by
failing to bill & collect for $250 million in services.
Indiana---this
209(b) state’s SPAP still excludes the disabled;
and, despite court suits, it
still has a much-stricter-than-SSI “209(b)” Medicaid disability rule
(one must be fatally or incurably ill).
Gov. Daniels (R ) & the then all-GOP legislature doubled CHIP
premiums & cut the HCB waiver budget $14 million; yet
let Medicare patients enroll in the risk
pool (which has no low
income premium discount) for
secondary coverage & added 500 more HCB waiver slots.
The state had to adopt ADAP cost
containments; and the ACLU sued challenging an
only-once-every-6-years limit on dentures & relinings.
Daniels’ $1 billion food stamp, welfare &
Medicaid eligibility privatization contract (that could shrink state
welfare jobs by 2,500) was limited
to one year only by the new House’s (now D) budget-–which,
he claims, also unaccountably “flat-lines’ Medicaid funding.
The state tightened its lax spend down procedures (but a class
action suit forced it to accept a consent decree reinstating 12,606
aged & disabled dropped with no hearing rights); and funded service
plans for 650 more disabled clients.
Doctors complained of the state’s enrolling patients in managed care
plans that pay even less than regular Medicaid,
so the
state then agreed to raise their fees. Daniels
plans an expansion
(via HIFA waiver and/or DRA-type plan
amendment) to subsidize insurance
for parents under 200% & for childless--even non-disabled--adults
under 100%, funded by a higher tobacco tax---using
HMOs, health savings accounts &
preventive care.
Iowa---Former
Gov. Vilsack (D) got a waiver for
watered-down Medicaid for 30,000 uninsured adults not on
Medicare—even if childless or non-disabled--with incomes under 200%
for care at 2 public hospitals (but with outpatient drugs available
only there). The risk pool
has no low income premium
discounts & no Medicare supplement; but added
state funds & Part D’s advent ended an ADAP waiting list. The old
legislature (R ) had studied ways to cut Medicaid,
but Gov. Culver & the new
legislative majorities (all D) are considering a $1/pack cigarette
tax hike to fund further expansions; and will work through a
bi-partisan planning board toward a “universal” health coverage
goal; cover 20,000 more children & 9,000 parents; raise Medicaid
income levels; and offer further insurance subsidies to more of the
uninsured working poor.
Kansas---a
Title XVI state. The GOP legislature passed a limited tax
credit to expand small firm coverage, health savings account
measures, a health care re-organization, abolished the SPAP 1/1/06 &
called for more anti-fraud efforts—but did
raise provider fees to about 65% to 83% of Medicare’s rates.
Blue Cross & a foundation subsidize
barebones insurance for Kansas City-area families making
under $30,000; but the state risk pool
has no low income premium
discount & no Medicare supplement. The state
offers Medicaid to the working disabled, the working “pre-disabled”
(only if they’re in the risk pool & are severely impaired) and the
working “medically improved”/ex- disabled”. Because the state plan’s
language limited coverage of disabled institutionalized children to
140/180 days—even though longer stays are allowed by federal law—CMS
questioned matching for over 500 of them, forcing their transfers to
regular foster care, small group homes or state hospitals. Gov.
Sibelius (D) called for cutting health care red tape costs and
bettering care for the aged, disabled & autistic children; but
federal audits disallowed or questioned $146 million in Medicaid
matching claims.
Kentucky---
Gov. Fletcher (R) & the split legislature raised Rx co-pays to $1
per generic, $2 per preferred brand name & $3 per non-preferred
brand name drug. But it dropped earlier-tightened nursing home & HCB
care medical qualification rules; raised the cigarette tax by 30
cents-a-pack with a further 10-cent raise under study;
reinstated 2,500 dropped CMI clients; and ended its ADAP
waiting list. CMS’ disallowance of state matching fund sources will
cost the state $100 million, and led it to get CMS approval for:
limits of 4-Rx’s-a-month, 15 occupational /physical/speech therapy
visits-a-year & 12 x-rays/ MRIs-a-year (with appeals allowed), $2 to
$10 co-pays for doctor visits, $2 to $20 co-pays for other
outpatient care, $10 to $20 co-pays for unneeded ER visits, a
$20 to $50 co-pay per hospital stay ; annual cost-sharing
caps of $225 a person & $350 a family (except for
non-Louisville-area patients, who’ll have a $450
cap); and co-pays of $3 per generic, $10
for “preferred” & $22 for “non-preferred” brand
name Rx’s for spend downers. There’ll be 4 Medicaid groups:
“healthy” adults; children; the aged & disabled (including LTC & HCB
patients); and MR & DD patients--each with its own benefits &
different, but higher, cost-sharing: See
http://www.kff.org/7530.cfm
for details. The state settled a lawsuit by starting to move 2,500
disabled into HCB care; and raised children’s dental rates by 30% to
keep & attract providers; but its risk
pool has no low income
premium discounts and no Medicare supplement.
Louisiana---cut
allowed Rx’s to 8 monthly (over-ride-able by doctors) and its
Charity Hospital & school health services, adopted a formulary;
may have to adopt ADAP cost-containments; and
its risk pool
has no low income discounts & no
Medicare supplement. Hurricanes cut state revenues $1 to $3
billion+ and forced a 10% cut in doctor fees. A healthcare board
is planning a Medicaid “re-design”;
and seeks federal funds to restore healthcare
& expand coverage. Gov. Blanco (D) likes the MA plan,
but CMS instead is offering minimal
funding--with even that contingent on privatizing the Charity
Hospitals. The legislature (D) offered Medicaid to the
working “pre-disabled” with mental illness (plus all the
working “fully” disabled) and the state
Health Secretary favors covering more children & raising the income
level for the disabled.
Maine---Gov.
Balducci & the legislature (both D) subsidize health insurance for
workers & dependents under 300%; raised the Medicaid level for the
childless to 125% (but then barred new childless, non-disabled,
non-aged patients) & for parents to 200%; plan coverage of
the working disabled; give limited waiver coverage to HIV+ persons
(even the “pre-disabled”) under 250%; adopted a formulary; raised
taxes on the rich, tobacco & alcohol to fund it all; are getting
caught up on backlogged provider payments; and set up a board to
study more health reform. But the state has
no risk pool. The
Medicaid agency proposed a $74 million reduction in
its state funds budget---justified by projected savings from “cost
controls” & “standardization” of mental health fees;
promoting preventive health; and more
chronic disease management.
Maryland---former Gov.Ehrlich (R ) closed CHIP to new
patients with incomes over 200% & raised its premiums; but the state
supreme court upheld a ruling voiding his denial of coverage to
legal immigrants here less than 5 years under the
state constitution’s equal protection clause. An AARP/Legal
Aid suit says the state’s HCB waiver medical admission rules are too
strict. The higher income SPAP excludes the disabled &
covers only Part D premiums; while the lower income SPAP was merged
with a state clinic care program into a new waiver for adults (even
childless & non-disabled) not on
Medicare under 116%. Despite a recent
dental fee raise, low specialist &
dentist rates attract too-few providers (e.g., only 20% of state
dentists) and one child with treatment access problems even died
after a tooth infection spread to his brain. The state
has a new risk pool with low
income premium discounts but
no Medicare supplement; and it offers Medicaid to the
working disabled. But in 2005 a state insurance board let small firm
health plans covering 450,000 persons drop meaningful drug coverage.
A tax on firms spending less than 8% of revenue on health insurance
was voided by a federal court and a state
appeal to the 4th Circuit failed.
The House (D) & a health study board favor
expansions (wider Medicaid eligibility, health insurance mandates,
subsidies & small employer incentives), funded partly by a new
$2-a-pack cigarette tax: The House
plan costs $372 million & the board’s $2.5 billion.
But Gov. O’Malley & Senate leaders
(also D) instead support only a 2nd study board,
expanded children’s coverage & modest insurance reforms.
Massachusetts---has no risk
pool. Former Gov. Romney’s (R) health cuts were killed by the
legislature (D). He restored dental care for women who are pregnant
or have children under 3---but called for tougher work rules
even for disabled welfare clients awaiting SSA
decisions; limited state “Free Care” patients to low income clinics;
and imposed $3 clinic & generic drug and $5 ER & brand name drug
co-pays on them. Yet he signed a
bill to expand Medicaid; require all residents to be insured; give
subsidies to foster employer coverage; subsidize health insurance
for those under 300% (adults will pay $18-$106 of an
average $380/mo premium); raise the
CHIP level from 200% to 300% ; restore adult dental & eyeglass
benefits; raise the parents’ level from 133% to 200%;
and offer more preventive
care. But the plan fails to raise
Medicaid’s childless aged (100%) & disabled (133%) levels to the new
200% level. Some doubt its financial sustainability (see
www.healthreformprogram.org
for critiques & details). CMS approved expansions/continuances of
waivers to cover HIV+ (including the “pre-disabled”) & childless,
non-disabled patients; and for DSH funds use.
Gov. Patrick (D) seeks $72 million for
public health preventive care & immunizations; and will carry out &
refine the reforms.
Michigan---has
no risk pool. Even with raised tobacco &
hospital taxes, it had to end almost all Medicaid adult dental,
hearing aid, podiatry & chiropractic care and stopped enrolling
new childless non-disabled adults under 100% into its
small Medicaid expansion outpatient care-only waiver. The then-GOP
House named a committee to find more Medicaid cuts and both houses
passed bills with more & higher Medicaid & SCHIP premiums & co-pays,
which Gov. Granholm (D) called “unprecedented in [their] cruelty”.
Yet she signed compromises to grandfather-in current
recipients; adopt some cost-sharing; impose some stricter
eligibility rules for some new applicants only;
abolish the SPAP 1/1/06; and even require patient urine tests for
smoking & sugary/fatty diets (violators face $10 penalty premiums).
But she restored adult dental care, raised
children’s dental fees to private-pay levels and child wellness &
adult preventive care rates 30%; asked CMS for $600 million more in
federal waiver funds to offer subsidized-premium insurance to the
working poor & small firm workers under 200%; and will use a $9
million federal Medicaid funds windfall to upgrade IT & data bases.
Wayne County (Detroit) began an outreach campaign to enroll
100,000 new Medicaid & SCHIP patients and Genesee County (Flint)
voted to fund subsidized coverage for uninsured workers & families
under 200% (Ingram [Lansing], Muskegon & Wayne Counties already
do the same). A court voided a law letting providers make patients
actually pay co-pays. The Senate (still R; the House is now D) voted
to raise cost-sharing higher & even more
strictly compel patients to
treat obesity, smoking, high cholesterol &
blood pressure. The state had to
adopt ADAP cost containments.
Minnesota---this 209(b) state has a risk
pool with low income premium discounts and
a Medicare supplement; it raised premiums & co-pays for
Medicaid, CHIP & MinnesotaCare (state-subsidized health insurance),
cut the latter’s income levels and denied Medicaid & CHIP to
legal aliens. While GOP plans to abolish state medical
assistance for the childless unemployed & the disabled awaiting SSA
disability decisions failed, nearly 30,000 still lost MinnesotaCare.
Other previous MinnesotaCare cuts were restored when
Gov. Pawlenty, the House (both then R) & the Senate (D)
adopted a 75-cents-a-pack cigarette “impact fee”. A court voided a
state law letting Medicaid providers deny care or Rx’s to
those who don’t make co-pays, yet the
state’s ADAP proposed to drop patients who don’t make its
co-pays. The SPAP was abolished on 1/1/06.
Yet Pawlenty funded a $2 million Rx discount plan for
uninsured & Part D donut hole patients;
$4.5 million more for the state SHIP; and Medicaid for
some diagnoses of the working “pre-disabled”, all the
“recovered/ex-disabled” & the fully disabled.
He asked the legislature (both
Houses now D) to expand SCHIP by 90,000 & MinnesotaCare by 23,000,
create a 2nd
barebones version of MinnesotaCare;
and raise LTC fees by $92 million & the mental health budget by $20
million; and will consider a “MA-lite” insurance mandate along with
wider reforms. Defying a federal proposal to lower Rx dispensing
fees, a state advisory board asked the legislature to triple
them to $10.
Mississippi---has no spend down;
its risk pool
has no low income premium
discounts & just dropped offering a Medicare
supplement. Gov. Barbour (R ) cut the aged/disabled level
from $1,000+ to $603 on 1/1/06 & slashed CHIP eligibility (65,000
aged & disabled & 2,500 children were dropped); reduced covered
brand name drugs to 2 monthly plus 3 generics (but HIV
patients get 5 brand names & there’s a suit
challenging the limits); and cut physical, speech & occupational
therapy. CMS forbade further use of a dubious state funding scheme,
forcing him to seek $90 million more for
Medicaid from the legislature (D) after hospital taxation ideas
faltered. Greater eligibility red tape forced 50,000 more off
the rolls.
Missouri---a
209(b) state; its risk pool
has no Medicare supplement &
no low income premium discounts. Gov. Blunt &
the legislature (both R) cut the aged/disabled income level from
100% to 85%; ended state medical aid & welfare for those awaiting
SSA disability decisions; dropped coverage of the working disabled;
cut the parents’ level to 23% from 75% (but a court reinstated those
who can also qualify in other categories); ended adult dental,
podiatry, hearing aid, appliance & eyeglass benefits (but an appeals
court let a suit against medical equipment denials proceed); enacted
new & bigger Medicaid co-pays; raised CHIP premiums; made 46,000
more children pay them; denied CHIP to those with “affordable” work
coverage, even if it’s really too costly (20,000 lost CHIP; but then
the state exempted families with work plan premiums over 5% of
income); and tightened medical rules for nursing home, HCB & home
health care. Yet CHIP co-pays were ended;
doctor & nursing homes rates were raised; and the SPAP was
expanded to cover the disabled (after
their 2 year Medicare waits). Blue
Cross & a foundation subsidize insurance for Kansas City-area
families earning under $30,000. The state restored eyeglass &
wheelchair items coverage. A 2006 referendum to raise tobacco taxes
to restore some Medicaid cuts & raise the income level toward 200%
narrowly failed to pass. Blunt condemned
Medicaid as an “outdated relic” and proposed further “reforms”:
Hiring MDs, RNs & lay workers as health care coordinators;
getting 5,000+ patients (even the disabled) to sign “independence”
contracts” to find jobs & give up Medicaid;
a $20 million insurance subsidy plan for
low income workers in firms of 50 or less; continued benefits for
foster children after age 18; further raising doctor fees; covering
more poor children;
using more
assigned
primary care doctors; managed care;
preventive care;
and dental & vision care “rewards”
for “compliant” patients.
The legislature’s
token
working disabled Medicaid restoration bill
still
excludes most SSDI & VA recipients. See critiques of the
reforms at
www.mobudget.org .
Montana---its
risk pool offers both low income premium discounts
and a Medicare supplement. Former Gov. Martz (R)
added more & bigger co-pays, restricted nursing home eligibility,
cut doctor visits for the aged & disabled to 10 yearly, dropped
coverage of some hospice & home health care. But Gov. Schweitzer (D)
and the now-split legislature ended the CHIP waiting list; covered
2,000 more children; funded buying pools to help small firms insure
workers (which he now wants to expand to
1,000 more workers); want a
HIFA waiver to fund a higher CHIP
level to cover 10,000 more children & give
barebones Medicaid to 3,000 more
adults; raised Medicaid’s family asset level to $15,000 (thus
switching 3,800 children from SCHIP, with a capped budget, to
Medicaid, which doesn’t) so as to cover more children; and
created a token SPAP for aged and disabled Medicare
patients under 200% (but it doesn’t cover the disabled
during the 2 year waiting period). State case & disease management
programs save over $20 million yearly
There’s an ADAP waiting list.
Nebraska----a
Title XVI state; its risk pool
has no Medicare supplement &
no low income premium discount. Former Gov.
Johanns (R) & the nominally
“non-partisan’ legislature ended coverage for 15,000 welfare-to-work
parents (a court order voiding/delaying much of the cut was upheld
on appeal).
The state will pay
Part D co-pays for dual eligibles in HCB waivers and board & care
homes. A state board seeks to save Medicaid $72 million yearly by
making it a “defined contribution” plan
& fostering assisted living & HCB waiver care over nursing
homes.
Nevada---a
Title XVI state with no spend down &
no
risk pool. Gov. Gunn (R) & the split legislature raised taxes
$1 billion for Medicaid; covered
the working disabled; upped the pregnant women’s level to
185%; raised the SPAP income level & covered the
disabled (even during the 2 year wait) in it;
will use DSH & SCHIP funds,
a HIFA waiver & a CMS risk pool
grant, for
barebones
insurance of small firm workers & families (with employers to pay
50% of—and workers to get a $100/mo subsidy for--premiums);
added some adult dental & vision care;
boosted state ADAP funding; raised CHIP premiums; rejected adding
co-pays to Medicaid; will raise
doctor/dentist fees 24%; and set up a board to study reforms.
New
Hampshire---a 209(b) state with a risk
pool that has no
Medicare supplement & no low income premium discount.
Gov.Lynch (D) expanded SCHIP; added state funds to ADAP; signed a
tobacco tax increase for health care; called for a $2 million boost
in home care rates & expanding
home-based care over nursing homes; proposed funding more SCHIP
enrollment; and plans better case/disease management.
But the state still has a stricter-than-SSI
“209(b)” Medicaid disability rule (inability to work for at least
4 years);
it
is enrolling all non-aged patients into
managed care; and, despite a 65%
fee increase funded by the legislature (now D),
children’s
dental rates are still too low to
attract enough providers.
New Jersey---has
no risk pool & privatized eligibility
determinations for SCHIP & Medicaid. But the parental level is again
being moved back up toward 133% (covering 80,000 more); a waiver
will cover all (even childless & non-disabled) adults under
100%; and HCB care is being promoted over nursing homes.
Gov. Corzine & the legislature (both D)
plan a “MA-lite” health coverage expansion to cover the uninsured
at a cost of $1.7 billion the first year,
but there’s a nearly $50 million state
funds SCHIP deficit and an audit questioned $52 million in
school health spending.
New Mexico—has
no spend down, but has a
risk pool with a Medicare supplement and
low income premium discounts; its
barebones Medicaid waiver-funded insurance for adults under
200% excludes Medicare patients. Gov. Richardson & the
legislature (both D) dropped some service cut & cost-sharing
proposals; changed eligibility re-certifications to once instead of
twice yearly; raised some income levels to 235% (covering 7,800 more
children & 1,200 more pregnant women); and
chose a task force to plan coverage expansions such as raising the
Medicaid waiver level to 300% to cover more modest income workers;
and giving Medicaid to all (even childless &
non-disabled) adults under 100%.
New York---has
no risk pool; a “Family Health” waiver covers
parents under 150% & all childless (even non-disabled)
adults under 100% except Medicare patients (who
must be under the lower SSI/SSP level to get it).
State-subsidized “Healthy NY” insurance for workers under 250%
excludes part timers & Medicare patients & caps yearly Rx’s at
$3,000. The split legislature
(D House; R Senate) still excludes
the disabled from the SPAP, even though Part D saves it $113 million
yearly; began forcing SSI recipients into HMOs; raised
FamilyHealth co-pays to $5 for doctors & dentists & to $3 for
generic & $6 for brand name Rx’s; raised other
Medicaid Rx co-pays to $1 per generic & $3 for brands; capped yearly
Medicaid co-pays at $200; set up a formulary allowing doctor
over-rides; is covering assisted living, chore aide & adult day care
over nursing homes; requested a waiver extension to keep letting
HMOs & clinics do eligibility enrollments; cut the aged/disabled
couple level by $75 monthly; makes the City & counties pay half of
non-federal Medicaid costs (but did cap their yearly increases at
3.5%); raised Family Health ER co-pays to $25; let providers deny
services to those who don’t meet co-pays; enacted slightly tighter
nursing home rules for asset transfers (but not for
living allowances or spousal support, or in asset rules for
home-based & HCB care); funded AIDS day care health centers; set up
a foundation to spend $250 million it got from Blue Cross on access
for the poor & preventive care; gave Medicaid to uninsured colon &
prostate cancer patients under 250%; and required hospital bill
discounts for those under 300% & banned taking homes from delinquent
debtors. Outgoing Gov. Pataki (R) signed a mental health parity
bill. Gov. Spitzer (D) pledged to strengthen outreach; enroll
900,000 more adults & 500,000 more children;
raise the SCHIP level from 250% to 400%;
bargain better for lower Rx prices; promote HCB & other
alternatives to nursing homes; and improve case management.
North
Carolina---has no risk pool;
it covered the working disabled (effective 7/1/07); and
increased covered Rx’s from 6 to 8 monthly (with exceptions
for 3 or even more additional ones). It abolished (1/1/06) but then
resurrected (1/1/07) a SPAP –
which again excludes the disabled under 65--for
those aged not eligible for Part D Extra Help with incomes under
175%. CMS forced cuts of $80 million in HCB care & home aides for
5,000 disabled. The state gave $75 million more to low income health
clinics and, while the UNC hospital system eased some indigent care
rules, it now makes patients pay up-front cash co-pays.
Children’s dental rates are too low to
attract providers. The state makes its counties pay 15% of
Medicaid costs but Gov. Easley & the legislature (both D) froze
their costs for 2007 (and he urged the
legislature to relieve this burden permanently) ; raised the
ADAP income level to 200% (adding $7 million more in state funds to
the ADAP budget in 2 increments); but cut money 75% for
kindergarteners’ eye exams. A federal audit says the state should
refund $15.5 million (plus $90 million more from hospitals) in DSH
funds.
North
Dakota---this 209(b) state has a risk pool
with a Medicare supplement
but no low income premium
discount. Fees are now too low to
attract providers & must be raised $17 million, according to a GOP
legislative study Yet Gov. Hoeven
(R) called for a $401 million Medicaid budget without
any fee increases, but for
promoting HCB care over nursing homes.
Ohio---a 209(b)
state with no risk pool.
Former Gov. Taft & the legislature (both R) cut the parents’ income
level from 100% to 90% (27,000 lost Medicaid 1/1/06); raised Rx
co-pays to $3; slashed the adult dental budget by 50%; ended adult
vision, podiatry & psychologist care; cut
secondary payments for dual eligibles; herded patients into
HMOs (one
plan then even cut transport to dialysis); took $80 million
from state Disability Medical Assistance (DMA) for 15,000 disabled
awaiting SSA eligibility decisions; and let
providers refuse service to those who don’t meet co-pays. Yet
they created over 2,000 new HCB waiver slots; beefed up home care;
moved 700+ patients into that care; and some GOP legislators
even proposed covering the working disabled.
But
they kept the monthly aged/disabled level at only $504 (the nation’s
lowest); and barred any new DMA
applications through 2006. A state audit said $400 million—plus $40
million in overpayments--can be saved by Medicaid streamlining &
reforms. Taft signed a mental health insurance parity bill before
departing. Medicaid spending fell $300 million yearly,
bringing calls to reverse earlier cuts &
bolstering Gov. Srtickland’s (D) plan to add 100,000 children to
SCHIP & to use Medicaid to subsidize insurance for 300,000 working
poor.
Oklahoma---this
209(b) state has a risk pool
with no Medicare supplement &
no low income premium discounts. It cut the
Medicaid level from 185% to 100% for children over 1 & from 100% to
the much lower SSI/SSP level for the aged & disabled, ended the
family spend down, re-imposed a
“3-Rx’s-a-month” limit and cut the nursing home & HCB waiver income
level. But Gov. Henry (D) covered the breast & cervical cancer and
working disabled groups; got higher tobacco taxes to fund a
HIFA waiver to subsidize
barebones insurance for 50,000+
workers & spouses 185%, in firms with under 50 workers---and
in 2007 proposed the plan’s further expansion. The split
legislature plans to cut $100 million in fraud & abuse;
change Medicaid into a defined contribution plan with a 2nd
HIFA waiver; offer fewer, “customized”,
cheaper benefits; offer only premium support instead of secondary,
wraparound Medicaid if patients can get work coverage; promote
health savings accounts; end private insurance benefits mandates;
cut ER & nursing home costs by promoting home, primary &
clinic care; raise provider fees;
and expand mental health care (with help from a federal grant).
A Senate panel voted to raise the SCHIP
level from 185% to 300%. But the
state ADAP had to adopt cost-containments.
Oregon---this
Title XVI state has a risk pool
that just dropped offering a
Medicare supplement but still
has low income premium discounts. An anti-tax
referendum cost 70,000+ adults their coverage via income level cuts
& premium raises; ended the spend down for all but transplant & HIV
patients (enrollment fell over 50%); limited adult dental care;
ended their vision care; and cut covered non-urban HMO hospital days
to 18 yearly. But Gov. Kungoloski & the
legislature (both D) created and then expanded a drug discount plan
and are considering additional health coverage expansion plans.
Pennsylvania---has
no risk pool, although the state subsidizes
barebones “AdultBasic” health
insurance for uninsured adults under 200%
(but it excludes Medicare patients & has no
drug benefit). Its SPAP
still fails to cover the disabled under 65, even though Part
D saves it $170 million a year. Gov. Rendell (D) & the old
legislature (R) arranged for the SPAP to wraparound Part D & pay its
premiums & cost-sharing for joint eligibles; cut covered inpatient
hospital stays to twice a year (but only once yearly for General
Assistance patients), inpatient rehabilitation stays to once a year
and doctor & clinic visits to 18 a year for men; rejected higher
co-pays & numerical limits for drugs; got $85 million more from
state Blue Cross plans for the AdultBasic budget to cover 30,000 of
the 120,000+ on its waiting list; got CMS
approval for & funded “universal” SCHIP; and offered Medicaid
to the working disabled & “recovered/ex-disabled”.
Rendell’s health expansion plan would use
higher tobacco taxes, re-directed AdultBasic & Community Health
Reinvestment monies, DSH funds, Medicaid waiver matching and a 3%
payroll tax on employers not offering insurance to subsidize
coverage for those making under 300% (with monthly premiums of $130
for firms of under 50 employees & of $10-$70 per adult for workers),
starting 1/08 & phasing-in some employer costs & mandates.
The plan does not seem to
raise the aged/disabled Medicaid level (now only 100% vs. a new 300%
subsidy level for workers) nor expand SPAP coverage to
the disabled. See
http://www.phlp.org/Website/alerts.asp for details/critiques.
The once all-GOP legislature now has split party control.
Rhode Island---has
no risk pool, but does have a 185%
parental/family income level. It added coverage of the
disabled over 55 to its limited-formulary SPAP; and offered Medicaid
to the working disabled. Gov. Carcieri (R) vainly attempted some
eligibility & benefit cuts, added $7
million+ in state funds to ADAP, signed a bill to subsidize
insurance for some low-paid workers in small firms (but it
also weakened the health insurance mandated benefits law) &
proposed cutting outpatient fees 10%.;
but a court voided his adoption of Medicaid drug co-pays without
the legislature’s (D) consent.
South
Carolina---has no spend down.
Its risk pool has a Medicare
supplement but no low
income premium discounts. Gov. Sanford & the legislature
(both R) cut Medicaid Rx’s from 4 to 3 monthly;
added co-pays for hospitalizations ($40),
ER visits ($25), doctor visits ($2), dentists ($3),
prescriptions ($3) &, medical equipment ($3)and
seek CMS approval for Medicaid health
savings accounts, enrolling Medicaid patients in a form of the state
employee health plan and more cost-sharing (e.g., $5 per Rx, $100
per hospitalization, $25 per outpatient surgery).
The SPAP has a 200% income limit; is funded as a Pharmacy
Plus Medicaid waiver; but excludes
the disabled.
Yet 4 patients died on
its ADAP waiting list: Previously, ADAP got only token state
funds, but it will now get $3
million more & $4 million next year in state money.
South Dakota---has
a risk pool with no
low income premium discount that excludes Medicare
patients and no spend down.
Gov. Rounds & the legislature (both R)
boosted cigarette taxes $1-a-pack to fund a $17 million Medicaid
deficit.
Tennessee----Gov. Bredeson (D) & the split legislature ended the
Tenncare waiver expansion, dropping 191,000+ adults, but no
children. Except for pregnant women, children & HIV+ persons,
doctor’s visits are limited to 10 &, hospital days to 20, yearly;
Rx’s are capped at 5 (2 brand names + 3 generics) monthly, with $3
or $5 co-pays except for HIV & Hepatitis C & drugs--and for many but
not all drugs to prevent death or hospitalization. The state adopted
a formulary; set Medicaid ER co-pays at $5; covered Weight Watchers;
ended methadone coverage; budgeted $20 million more for low income &
county clinics; will raise Medicaid levels for pregnant women &
infants; add hundreds of HCB waiver slots; raise the CHIP level to
250%; subsidize
barebones
health insurance (at first only for workers
under 250%, but later for the aged & disabled), starting 3/07 &
closed, at least to begin with, to employees of non-participating
firms); revive a risk pool (with
no Medicare supplement, but with priority for
dropped Tenncare chronic cases & a premium
discount for those under 200% that
still costs $160 monthly); and
created a SPAP—with new enrollments
already now suspended due to an unfunded,
overwhelming number of applicants--to cover generics & some
but not all brand name drugs for anyone (aged, disabled or
not) without dug coverage & with income under 250% (generic co-pays
are $3 to $10). CHIP co-pays are $5 for generics & $20 (!) for brand
names; $15 per doctor visit; $50 (!) per ER visit; $100 (!) per
hospital stay; and, except for also exempting insulin, diabetic
supplies & some mental health drugs, CHIP has the same Rx limits &
exceptions as Medicaid. See
www.tenncare.org &
www.researchcouncil.org
for details. The state stopped covering benzodiazepines &
barbiturates (even for anxiety, epilepsy, seizures &
mental health, over-riding its own Rx board)
Texas—has
a risk pool that just dropped
offering a Medicare supplement & has no low
income premium discounts. Gov. Perry & the legislature (both
R) ended the family-only spend down & CHIP coverage of prostheses,
physical therapy & private duty nursing; tightened CHIP asset rules;
imposed $10 to $20 co-pays for CHIP doctor visits & Rx’s; raised
CHIP premiums; imposed a 90 day wait to enroll in CHIP; cut
Medicaid home health care; and ended adult chiropractic & podiatry
coverage. A law denying Medicaid to parents who abuse drugs or
alcohol or whose children miss school or checkups was voided by a
court. The state wants a waiver to force TANF families in 8 large
counties into HMOs that will spend $109 million less on their
care each 2 years, but there are delays in HMO plans for the aged,
disabled & institutionalized. The eligibility privatization
contractor’s service was so poor (122,000 children lost coverage,
even though a study said over 50% of applicants had proper
documentation), that the state suspended the contract, asked some of
the 2,900 laid-off state eligibility workers to return and gave
28,000 CHIP cases more time to complete forms.
The state ADAP eased access to Fuzeon. A federal court ruling
requiring better EPSDT outreach was allowed to stand on appeal. The
state restored Medicaid and CHIP mental health, vision & hearing aid
coverage and CHIP dental care, but revoked a Planned Parenthood
birth control contract (because it privately funds abortions)
and uses less experienced clinics instead. It
now offers Medicaid birth control & preventive screening services to
women 18 to 44 (even if childless or not disabled)
under 175%. Perry is considering
using DSH funds to finance low income health insurance;
Medicaid health savings accounts;
a waiver to raise cost-sharing
even above DRA-allowed levels; offering only premium
support instead of secondary, wraparound Medicaid if patients can
get work coverage; and ”selling” the lottery
(with 20% of proceeds funding a trust to
pay out $250 million yearly to cover some of the uninsured).
Utah---this
Title XVI state has a risk pool
with no Medicare supplement &
no low income premium discounts. A
HIFA
waiver, gives barebones
Medicaid (no hospital, specialists’, nursing home or home health
care; high drug & other co-pays) to uninsured adults (at first only
parents, but now even the childless) under 150% & not on Medicare
(but only if they apply during rare application periods). The state
offers full Medicaid to the aged & disabled under 100%; but
the GOP legislature ended coverage of adult podiatry
(even for brittle diabetics);
audiology; speech, occupational & physical therapy; vision and
dental care (one patient’s untreated tooth
infection caused fatal meningitis); and
won’t raise doctor fees (now so low they
deter most providers) or offer more needed specialty care to
the severely disabled. Gov. Huntsman (R) even had to solicit
private donations for dental care, yet still
began subsidizing up to $150/mo (plus $100
per child) of the employee share of job health plan premiums for the
working poor (eventually for up to 4,000-9,000), and a study board
he appointed is considering more expansions.
Yet, even with a $1.6 billion surplus, the GOP
legislature wants more Medicaid cuts (i.e.,
“consolidating” eligibility staffing; a 5% budget increase cap).
The health agency’s formulary proposal
was crippled when the Senate added a wide, “dispense-as-written”,
automatic formulary-override loophole.
Vermont—The
legislature (D) only partially
reversed Gov. Douglas’ (R) elimination of adult dental care
(dentures aren’t covered & there’s a $495
annual cap) and providers’ fees are too low to keep & attract them.
But CMS & the legislature approved his
HIFA waiver which, in exchange for
$400 million extra to meet a 5 year deficit, forces patients into
HMOs, promotes HCB care over nursing homes & tightens up asset
transfer bans-- but also caps future federal funds.
There’s no risk pool,
but a bi-partisan law cuts family premiums 50%, raises tobacco taxes
and charges $365 to employers that don’t offer health insurance to
fund subsidized, sliding scale premium private insurance for those
under 300% starting in 2007.
Virginia---a
209(b) state with no risk
pool. Former Gov. Warner (D) extracted $1.3 billion in new
business & tobacco taxes from a reluctant GOP legislature to prevent
cuts; raise hospital, nursing home &
dental rates; fund 850 more HCB waiver slots; and cover
100,000 more children. Gov. Kaine (D) authorized Medicaid for the
working disabled & a SPAP to pay for cost-sharing & drugs uncovered
by Part D plans for HIV+ Medicare patients under 300%; proposed
raising the nursing home PNA by $10, the pregnant woman level from
166% to 200% and pediatric fees by 15%;
and named a board to strengthen Medicaid & plan coverage expansion.
The GOP legislature still favors Medicaid health savings accounts,
forcing more patients into HMOs & raising their cost-sharing--yet
both parties’ leaders want further raises
added to recent 30% dental & OB/GYN fee increases to keep & attract
providers; and the legislature’s separate
health study board favors offering “extras” (e.g., adult
dental care, gym fees) to patients who get preventive care
or are otherwise “compliant”.
Washington---had
a risk pool with a Medicare supplement and
low income premium discounts, that
somehow morphed itself into a SPAP; restored earlier
children’s eligibility cuts; and expanded Basic Health
(state-subsidized, barebones
insurance) by 6,500. It set up a health access board; won’t impose
children’s Medicaid premiums; restored limited adult dental care;
and will cover co-pays for Part D Extra Help patients into 2007.
Facing a $500 million health cost increase by 2009, and a state
audit (which the federal IG said was at least partially
incorrect) finding $1 billion in past improper Medicaid spending,
Gov. Gregoire & the legislature (both D) will reform administrative
& Rx controls; adopt case management for chronic cases; cover
assisted living facility care with a RWJ grant & a Medicaid waiver;
enroll 32,000 more children in SCHIP now
& all children by 2010;
cover foster children after age 18; and make health plans let
children stay covered as parents’ dependents until 25. King
County found $2.4 million to keep 4 low income clinics open;
the state & Group Health Cooperative lowered Basic Health’s
2007 premiums; and a state hospital
association pledged to limit fees for those between 100% & 300%
(although state law already
requires much the same in free care & discounts).
West
Virginia---the state adopted a monthly limit of 4 brand name drugs
but Part D’s advent & some added state funds allowed it to eliminate
its ADAP waiting list. Its new risk pool
has no Medicare supplement &
no low income premium discounts. It cut medical
equipment, transport, incontinence, & wheelchair supply funds;
but failed, in bungled & callous attempts,
to tighten admission criteria for HCB waiver care:.
Legislators & advocates have since
criticized those attempts & support a bill to require that the
Medicaid advisory board & the legislature be briefed on & agree to
changes. Gov. Manchin & the legislature (both D) passed bills
to offer primary clinic care only to the uninsured employed
poor (but only with employer support),
subsidize $99-a-month private insurance for the working
poor and raise the CHIP level from 200% to 300%--all
effective in 2007 (but he later sought to delay the CHIP
liberalization for at least a year). The state will assign primary
physicians to patients, place them in managed care & offer them
extra “bonus” services (e.g., “emergent” adult
dental care; uncapped drugs; preventive, anti-smoking,
diabetes, fitness & diet services; etc.). At first enrollment will
be “voluntary” & just for families (but it might later cover
the disabled & aged) who sign “personal responsibility”
contracts--with bonuses denied to non-signers & contract breakers
(who’d then face more cost-sharing).
Wisconsin---covers illegals’ prenatal/childbirth costs, got its
Pharmacy Plus waiver-funded SPAP (which
excludes the disabled) extended to 6/30/07 & is
moving 25% of nursing home patients into cheaper at-home & HCB
waiver care. Its risk pool has
a Medicare supplement and low income premium discounts.
Gov. Doyle (D) vetoed the old GOP legislature’s health savings
account bill & asked the new, now-split legislature
to raise the parents’ level from 185% to
200%,; set up state-sponsored
reinsurance to lower premiums (by assuming catastrophic costs) of
small firms’ insurers: open BadgerCare (a waivered
Medicaid/SCHIP expansion for families, with a much-higher-than-SSI
income level of 185%-200%) to all adults, presumably
even the childless aged & disabled (all
to be funded by added tobacco, hospital, car registration, energy &
real estate transfer taxes); enroll
those on SSI (except MR & HCB patients) in managed care unless they
expressly seek exemption; and ease
excess red tape
now impeding children’s eligibility.
Wyoming---has
no spend down and its SPAP is open to anyone
under 100% who’s not Medicare-eligible. The GOP
legislature cut the mental health budget by nearly half (even with a
$1 billion surplus & a state chronic case management plan saving $30
million yearly); but seeks to give
barebones
coverage to CHIP parents under 200% (with
higher co-pays, but premium-free
for those under 133%) and to get a Katie Beckett waiver for
mentally ill children. Gov. Freudenthal
(D) requested $5 million more for the risk pool, which has
a Medicare supplement but no
low income premium discounts.
SOURCES AND
RESOURCES:
For the
48 states & DC, the
new
2007
federal poverty level (FPL) is
$10,210 yearly ($851 monthly) for one plus $3480 yearly ($290
monthly) for each add’l person;
see the Asst. Secy. for Plan. & Eval. pages at
www.dhhs.gov for AK & HI.
Email
sherry.barber@ssa.gov for a hard
copy of “State
Assistance Programs for SSI Recipients, 2006”
on
states’ Medicaid eligibility rules for
SSI recipients & their Section 1616, 1634 & 209(b) arrangements; if
they offer--plus amounts of & who administers—SSPs, or State
Supplementary Payments (including those for residents of board &
care homes); and state-SSA welfare interim assistance reimbursement
agreements for indigents
awaiting SSI.
See
“Medicaid and SCHIP
Eligibility for Immigrants” (4/06) at
http://www.kff.org/medicaid/upload/7492.pdf
on limits for federally-matched Medicaid
and SCHIP coverage of both legal and illegal aliens.
See
www.kff.org/medicaidbenefits
for states’ 2003-04 “optional”
coverage of chiropractors, podiatry,
dentistry, dentures, orthodonture,
eyeglasses, optometry, hearing aids, audiologists, psychologists,
prosthetics, medical equipment, hospices and physical, occupational,
speech & other therapy, which
some states later cut in 2004-05.
See
“Outline on State
Medicaid Cutbacks & Responsive Advocacy” at
www.healthlaw.org for
legal rules states must meet to make cuts & legal arguments against
them. Guides & arguments to oppose cuts
appear at www.familiesusa.org
, www.cbpp.org ,
www.communitycatalyst.org &
www.TAEP.org ; and
www.communitycatalyst.org has a study on the consumer role in
health advocacy & expansion in 16 states and advice for consumer
reform advocacy in all
states.
See these DRA
advocacy guides,
at
www.healthlaw.org : “The Role of State Law in Limiting
Medicaid Changes” for a
state-by-state analysis of state statutes on who can change state
Medicaid plans (i.e., to raise cost-sharing or reduce benefits),
“Q and A: State Medicaid Plans”
on preparation & submission rules and
procedures for state plan amendments and
”The Deficit Reduction Act of 2005: Implications for
State Advocacy” for tips to prevent
such plan amendments. See
http://www.nachc.com/advocacy/Files/state-policy/model520state520legislationh.pdf
and
http://www.nachc.com/advocacy/Files/ModelStateLegislation-AppropriationsRiderssr031406_RS-.pdf
for a model statute requiring that plan changes/waivers be
approved by legislatures & not just by Governors or Medicaid
agencies.
See
“Waiver Watch” at
www.healthlaw.org , “Waiver Tool Box” at
www.familiesusa.org, “Coverage Gains Under Recent Sec. 1115
Waivers” (8/05) at
www.kff.org & materials at
www.cbpp.org for news & details on
state waivers.
See
“ADAP Watch” at
www.NASTAD.org for
the latest details on state waiting
lists, cost containment measures & state websites.
The “National ADAP Monitoring Report, 2006: Key ADAP Highlights”,
Chart 1, pp.1-2, at
www.kff.org lists
state income levels. See
the adjacent full Report
for state
cost sharing rules& medical criteria and/or prior authorization
needed for special or costly
drugs. State ADAP formularies
are in a 2nd adjacent document.
Email
alefert@nastad.org for a chart of
state ADAPs’ policies & procedures to coordinate with /wraparound
Part D.
States’
August, 2003 cost-sharing, premium &
co-pay rules & amounts are in
“Medicaid and SCHIP: States’ Premium
and Cost Sharing” (03/04) at
http://www.GAO.gov/new.items/d04491.pdf ;
but see more recent
state drug co-pay
data in the “State Medicaid Prescription Drug
Reimbursement Chart– March, 2005” at
www.ascp.com .
See
“Pharmaceutical Benefits
Under State Medical Assistance Programs, 2004” (Section 4, pp.
24-46) under “Resources” at
www.npcnow.org on state
formularies, payments, any over-the-counter product coverage, prior
authorization, prescribing/dispensing limits & drug co-pay
amounts & any cumulative co-pay amount caps.
See
http://www.ncsl.org/programs/health/SPAPCoordination.htm &
http://www.medicare.gov/spap.asp on
State Pharmacy Assistance Programs (SPAPs), their eligibility &
coverage rules, and how they
coordinate with Part D.
See
http://www.cms.hhs.gov/partnerships/downloads/1126P.pdf
for
new, 2007
Part D LIS/Extra Help
premiums, deductibles,
co-pays/coinsurance, income & asset levels; and Special Enrollment
rights for those who lose LIS.
Email
jcoburn@hdadvocates.org for a chart on how drug makers’ own
corporate charity Patient Assistance Programs (PAPs) coordinate
with, supplement & interact with Part D:
“PAP Eligibility Criteria & Medicare
Part D” (12/06).
See
http://www.epocrates.com (subscription required) for
regularly updated formularies for each
Part D drug plan.
While Part D
displaces Medicaid for most drugs for dual eligibles,
those 6 narrow classes of drugs that
are specifically excluded by the Part D law can still be covered
for them by Medicaid; such state coverage is re-tabulated from CMS
surveys at
www.medicareadvocacy.org/Part D_ExcludedDrugsbyState.htm
(12/1/05 report under “News”
icon).
See
“Individual Budget-Based Models of LTC’ (1/06) at
www.statehealthfacts.org for
states’ coverage of HCB waiver, home health, personal care aide &
patient-directed home-based care as alternatives to
institutionalization.
A list of 2006
state-set personal needs allowances (PNAs) for patients in Medicaid
SNFs & ICFs and for residents in state-licensed, SSP-funded board &
care supervised group homes is available from
lsmetanka@nccnhr.org .
See
www.statecoverage.net/ for
“State of the
States, 2007” a comprehensive survey of
states’ Medicaid & health insurance coverage expansions and plans as
of late 2006 (but see more recent sources for CA & PA reform
details).
See
www.naschip.org on state health
insurance risk pools and to order “Comprehensive Health
Insurance for High Risk Individuals: A State-by-State Analysis, 20th
Ed.” ($39.95; hard copy only) on state
risk pools: websites, funding, eligibility, benefits, any Medicare
supplements, premium amounts and premium discounts for low income
patients.
Email
asuchman@aphsa.org for Center on
Workers w/ Disabilities newsletter; federal & state eligibility
rules for their health coverage are in TIICANN’s “State
Medicaid Buy-in..” & “Returning to Work...”
guides at
www.healthlaw.org
See”
TIICANN materials” under the new items
listing at
www.healthlaw.org for “
Painless Ways To Deal
With State Medicaid Shortfalls”;
“State Aged/Disabled...Income Levels”
and “State...Parental...Income
Levels”; a
health & Medicaid “Glossary”;
“SPAPs , Part D and...the Disabled”; “How States Can
Make More Patients Eligible for...Pt. D Extra Help at Little or
No...Cost…”; and “2007
VA Health...Benefits”.
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