Medicaid Watch: State Medicaid and Health Cuts & Expansions
August 31, 2010: See p 13-14 for updated sources & resources on state health programs
Alabama--has no spend down, an aged/disabled level of $674 (the SSI rate), a parent level of 11%/ 24% if wkg (‘10) & an ADAP level of 250%; covers 12 MD visits & hosp days/yr & 5 brand name Rx’s/mo & has an ADAP enrollment cap. Medicaid’s shortfall is $64 mil-lion for 2011. Gov. Riley (R) & the legislature (D) cut HIV care $2 million but it overrode his veto to raise CHIP’s 200% level to 300%. The risk pool’s adding low income premium discounts but has no Medicare supplement There are 2,500 on the HCB waiver waiting list
Alaska---this Title XVI state has no spend down, an aged/disabled level of $1,252 (its SSI/SSP rate), a parent level of 77/81% if wkg (‘10), a 300% ADAP level, a risk pool with a Medicare supplement but no low income premium discount & a token SPAP for those under 175% that excludes the disabled. In spite of a $60 million 2011 deficit, Gov. Parnell (R) & the legislature (R House; tied Senate) raised the 175% CHIP level to 200%.
Arizona--has no spend down or risk pool & covers parents & childless-even non-disabled-adults under 100%/106% if wkg. CHIP’s level is 200% & ADAP’s is 300%.The legislature (R) killed a program to cover the disabled during Medicare’s 2 yr wait, cut MD fees & personal care funds & at first dropped 310,000 clients. With a $394 million 2011 deficit, Gov Brewer (R) cut ADAP’s formulary (and may start a waiting list & co-pays) & mental health funds, left 3,800 CMI clients with no way to cover care & ended hospice & cut home care--but then chose not to drop the 310,000 clients or abolish CHIP (yet kept a CHIP freeze inplace that’s cut enrollment from 45,800 to 33,700 since 1/10--with a waiting list of 40,000)
Arkansas—has an aged/disabled level of $674 (the SSI rate), a parent level of 13%/17%
if wkg (’10), a numerical Rx limit & subsidizes insurance for small firm workers below
200%. Gov. Beebe & the legislature (both D) covered adult dentistry & passed an unfunded bill to raise CHIP’s 200% level to 250%. The risk pool bans Medicare patients but seeks US funds for a low income premium discount. Beebe may cut the number of MD visits & Rx’s, did cut ADAP’s formulary & its level from 500 to 200%, but ended a waiting list.
California--The under-funded, often-closed risk pool (one private insurer offers a “look-alike” policy for slightly more than the pool) has no low income premium discount & bars non-renal Medicare eligibles. The state covers the aged/disa-
bled under 100% (with a $230, not just $20, disregard), parents below 100%/106% if wkg & prostate cancer patients un-
der 200%.ADAP’s level is 400% & CHIP’s is 250%. With a $19+ billion deficit, Gov. Schwarzenegger (R) & the legisla-
lure (D) raised premiums; capped child dental care at $1,500-$1,800/yr; dropped adult dental and some podiatry & psychi-atric benefits; ended non-emergency care for legal aliens; and cut provider fees & the HIV budget (the last by $85 million, with $12 million from ADAP). A $2.75 billion Medicaid cut caused 3 million adults to be dropped. He denied ADAP to localities’ jail inmates and proposed ending TANF & family medical coverage, home health care & personal aides for the disabled, low income clinic funding, OTC Rx coverage & adult day health care; plus limiting Rx’s to 6/mo (except “life-saving” Rx’s) & MD visits to 6/yr & requiring $50 ER co-pays. Courts barred MD & hospital fee cuts, eliminating adult day care & optometry services, a 20% personal aide pay cut & line item vetoes of HIV & other health funding. LA Co’s Health Dept has a $389 to $429 million 2011 deficit (2010’s was $200 million) that could cut patients served by 1/3 to 1/2
Colorado---has no spend down. The level for those over 60 is $699 (their SSI+ SSP rate), but it’s only $674/mo (the SSI-only rate) for younger disabled. ADAP ‘s level is 400%. The risk pool has low income premium discounts for those below $50,000 & Medicare supplements. Gov. Ritter (D) began a formulary, made health plans cover PTSD, anorexia, substance
abuse & colorectal screening, proposed de-funding 79 mental health facility beds & reducing low income clinic funding, and cut ADAP’s formulary. Medicaid’s caseload is up 200,00 since 2001, but he & the legislature (D) passed a hospital tax to raise $600 million for Medicaid, CHIP & the state indigent medical program; boost hospital rates & uncompensated care funding; and cover 100,000 more persons by raising all adult levels to 100% (now in effect for parents & by 2012 for childless, non-disabled adults) with newly-offered health reform matching; applied the mini-COBRA law to small firms; raised CHIP’s level from 205 to 250% & widened its psychiatric care; covered the working disabled below 450%, began a SPAP for HIV clients; covered legal aliens; set a 300% level for nursing home & HCB waiver care (with no patient num-erical cap, and with related “CAHI” [www.coahi.org] & self-directed personal aide programs); and let HMOs sell cheap policies to the uninsured---but cut funds for DD & disabled clients’ employment, transportation & personal aides’ pay.
Commonwealth of the Northern Marianas—federal law caps its matching rate far below what states get & it can’t even fully fund its own share of Medicaid even though 37% of residents are poor enough to get it. Its low fees attract few MDs & DDSs (only public clinics), but it enrolled some off-island specialists by agreeing to pay Hawaii’s higher Medicaid fees
Connecticut—a 209(b) state; its 2 zone aged/disabled levels are $784.22 & $888.61(its SSI/SSP rates for those with max- imum allowed shelter costs + a $278 disregard), its parent level is 185%/191% if wkg; its ADAP level is 400%; its CHIP level is 300% and its risk pool has a low income premium discount for those under 200% & a Medicare supplement. Gov. Rell (R) raised SPAP premiums, co-pays & asset levels (income levels are $25,100 for 1 & $32,900 for 2); limited adult chiropractor, naturopath, psychologist and occup, physical & speech therapy coverage to clinics; but extended hospice care to all Medicaid patients. She moved to cut HIV services $2.7 million, delay starting an HIV HCB waiver, raise CHIP & Medicaid cost-sharing, drop most adult dental, eyeglass, OTC drug &, legal alien coverage and cut SPAP benefits. The legislature (D) covered the working disabled. Rell wants to force patients back into HMOs to fund her skimpy, subsidized insurance plan for those under 300%. With premiums up 72% since 1/10, it has high co-pays, limited psychiatric care, low Rx & medical equipt yearly cost caps, a $100,000/yr total care cap & a $1 million lifetime cap and may even have to close enrollment. The state was approved to get newly-offered matching to widen Medicaid to childless, non-disabled adults un-der 56% who’ve been eligible for Gen Med Asst (keeping its $150/mo earnings disregard), extended COBRA coverage to 30 mos, ended QI’s asset test & raised QMB’s level to 207%, SLMB’s to 227% & QI’s to 242% (giving most SPAP cli-ents full Pt D Extra Help too). The 2011 deficit is $263 million. Medicaid’s caseload rose 18% in 2009 & 33% since 2004.
Delaware---has no spend down or risk pool; covers all adults under 100% (121% for working parents & 110% for wkg childless, non-disabled adults); the ADAP level is 500% and those for CHIP & the SPAP are 200%. Gov. Markell & the legislature (both D) operate a state-funded cancer care assistance program for those under 650% & state-funded medical assistance for anyone else under 200%, covered the working disabled and may let over-income children buy into CHIP.
District of Columbia---has no risk pool. Income levels are 200%/207% if wkg for parents, 100% for the aged & disabled, 300% for CHIP & 400% for ADAP. Local DC medical assistance covers others under 200%/211% if wkg. Mayor Fenty & the Council (both D) covered adult dentistry; boosted the aged/disabled asset level $2,000, raised QMB’s income level to 300% & dropped its asset test (thus entitling many DC Medicare patients to Pt D’s full Extra Help). DC is replacing public mental health clinic care with private contractor services. Fenty proposed cutting funding for low income clinics & also slashed the only-recently-raised MD fees. DC’ is now expanding Medicaid to cover childless, non-disabled adults who’ve been eligible for local medical assistance using newly-available US health reform matching. It is keeping the safe-ty net, debt-ridden United Med Ctr (formerly Greater SE Hosp) open after buying it at public auction (it ran up huge defi-cits even while DC was subsidizing it $70+ million & also raising its Medicaid fees to 95%-100% of its overhead costs)
Florida---The legislature (R) got a waiver to shift patients (a court order does let them opt out) into contract managed care; but the state has so far done so in only 5 counties & a state request to extend the waiver is now being questioned by CMS, especially since the waiver still doesn’t extend to more counties--much less statewide .The under-funded, usually-closed risk pool has a Medicare supplement but no low income premium discount. The legislature cut the aged/disabled level from 88% to the $674 /mo SSI rate, but covers those under 88% in HCB care or in Medicare’s 2 year disabled wait-ing period. The parent level is 21%/ 53% if wkg (‘10) & ADAP’s is 400%. The state covers dentures (but little other adult dentistry) & hearing aids. Gov. Crist (R) dropped Zyprexa & Invesa Sustena as covered Rx’s & favors letting children ov-er its 200% level buy into CHIP. He made private plans cover autism care, gutted the insurance minimum benefits law & fostered cheap barebones policies for the uninsured (see
www.coverfloridahealthcare.com; start-up is delayed to late 2010 & policies may not meet new US health reform insurance rules unless its gets an HHS waiver). Also, Blue Cross & a local health dept. sponsor cheap ($105/mo for 1 person under 250%), barebones “Miami-Dade Blue” policies with no Rx brand coverage. Crist dropped hospice & cut dialysis care; and slashed mental health & substance abuse funds & MD fees Home & HCB care waiting lists are long, but to settle a suit the state is spending $27 million more on HCB waivers. Crist restor-ed $22 million for care of the aged, disabled & special need children and mental health & substance abuse care; raised cigarette taxes $1 to yield $1 billion (much for Medicaid), vetoed nursing home & DD care fee cuts; and signed a bill to make insurers sell Medigap policies almost as fairly to the disabled as to the aged. Miami’s Jackson Mem Hosp is closing 2 O/P clinics & 2 transplant units; ending dialysis care for 175 indigents (many of them illegal) & may close its North sat-elite branch. The ADAP program has a waiting list of 1,361 (but just got $6.97 million more in extra US funding) & cut its formulary. The HIV insurance premium assistance program level is also 400% (but neither it nor ADAP have any asset test) but is short $1.5 million even after getting $1 million from other HIV accounts--and has its own waiting list of 260+
Georgia---has no risk pool. Its aged/disabled level is only $674/mo (the SSI rate), its parent level is 28%/50% if working (‘10), ADAP’s is 300% & CHIP’s is 235%. It has a monthly numerical limit on Rx’s; dropped CHIP coverage of dental surgery & raised its premiums; ended adult emergency dentistry & artificial limb benefits and nursing home spend downs
and narrowed Katie Beckett waiver admission rules. Gov. Perdue & the legislature (both R) herded patients into HMOs, but allow opt outs. Provider fees are too low. Atlanta’s Grady Hosp, once short $40+ million due to indigent care costs, closed its dialysis clinic and 3 of its 9 O/P clinics and cut its free care income level from 250 to 125%; but the shortfall later fell to $4.4 million. With 2011’s $270 billion deficit & $506 million Medicaid shortfall, Perdue dropped plans for provider fee raises & may cut ADAP $1.2 million. He’ll sign a 1.45% hospital bed tax (proceeds will attract more US funds to bolster Medicaid hospital fees), but MD & DDS fees will still be cut (again). He seeks insurance taxes & fines to meet health costs, closed a mental hospital building, raised CHIP premiums, cut pregnancy & infant care funds; has an ADAP waiting list of 449 (but just got $731,000 in extra US funding) & may privatize some mental health care.
Guam—this territory’s matching funds are capped by law far below what states get. Its local medically indigent program (MIP) pays even less than Medicaid & has almost no private providers. Scanty funding for off-island specialty care & air transport to it runs out quickly. Provider fees are too low & paid too late. Only 1 dentist takes Medicaid & CHIP patients
Hawaii—a 209(b) state with no risk pool. A limited Medicaid package covers all adults (even childless & non-disabled) below 200% but full Medicaid is open only to parents & the aged & disabled under 100%. ADAP’s level is 400%. The state covers the working disabled & has a SPAP for Medicare patients under 100%. Gov. Lingle (R) & the legislature (D) raised CHIP’s level to 300%, ended its premiums & let richer children buy in. With a $86 million 2011 deficit, Lingle cut HIV services $300,000, closed ADAP, to those with CD4 counts over 350 (it has a waiting list of 17, but just got an extra $148,000 in US funds), began moving 37,000 aged & disabled into managed care & ended non-emergency adult dentistry
Idaho---a Title XVI state, with no spend down, an aged/disabled level of $707 (the SSI/SSP rate), a parent level of 21%/ 27% if wkg (‘10), an ADAP level of 200% & a risk pool with no Medicare supplement or low income premium discount. The legislature (R) raised the CHIP level from 150 to 185%; funds an under-used pilot plan for workers under 185% in participating small firms, covered the working disabled & sorted clients into 3 groups: Parents & children; disabled & chronic cases; and the aged. The 3 groups may get differing benefits or more co-pays but also more preventive care. Gov. Otter (R) covered adult dentistry but charges premiums of 4% of income to Katie Becket cases. With an $86 million 2011 deficit, the legislature may charge all disabled children extra premiums, did cut hospital, MD, rehab facility & DD agency fees 55% (but a court then voided those cuts); and slashed occupational & speech therapy and mental health funds. ADAP has a waiting list of 27. The House voted to end the state’s adult cystic fibrosis program & drop non-emergency transport.
Illinois---this 209(b) state’s aged/disabled level is 100% (with a $25, not just $20, disregard). Its main SPAP excludes those disabled not yet on Medicare, who instead get only a limited formulary from a 2nd SPAP. Both SPAPs’ income lev-els are the same: $27,600 for 1, $36,635 for 2, etc. The legislature (D) raised the parent level to 185%, accepted a court order to raise pediatric fees (yet other fees are too low & paid very late, with a $4 billion unpaid claims backlog), offered subsidized insurance to veterans left uncovered by VA cuts & raised CHIP’s 200% level to 300%. The often-closed risk pool has a Medicare supplement but no low income premium discount. The state is forcing 40,000 aged & disabled into HMOs but raised the wkg disabled level to 350% & required that Medigap policies be sold as fairly to the disabled as to the aged. The U of Chicago Med Ctr closed its women’s & dental clinics & the U of IL at Chicago closed a clinic too. The state gave $640 million to safety net hospitals, made hospitals give the uninsured discounts & funded a hospital “assess-ment” plan to raise enough to attract $450 million more in US matching. With a $13+ billion deficit, the legislature gave Gov. Quinn (D) full authority to cut the budget (at least $500 million in unspecified health & welfare cuts are expected). He hopes to save $400 million more with case management for the aged & disabled (38,000 of whom are on HCB care waiting lists). ADAP’s shortfall is $10 million--causing a reduced formulary & a cut of the 400% income level to 300%.
Indiana---this 209(b) state’s token SPAP for those under 150% excludes the disabled; and it has a much-stricter-than-SSI “209(b)” Medicaid disability rule (one must be fatally or incurably ill). The aged/disabled level is $674 (the SSI rate) & the regular Medicaid parent level is 19%/25% if wkg (‘10). Gov. Daniels (R) & the old all-GOP legislature raised CHIP premiums. The risk pool has a Medicare supplement & a low income premium discount. The ACLU sued to void a once-each-6-yrs denture replacement & re-linings limit. The House (now D) opposed Daniels’ troubled & now-canceled eligib-ility privatization contract and a class action suit sought to counter contractor eligibility failings. The ADAP (with a 300% level) may have to start a waiting list and 21,000+ DD clients are already on a HCB waiver waiting list. The state raised CHIP’s level from 200 to 300%. A waiver subsidizes insurance for parents below 200%--and even has up to 42,000 slots for the childless, non-disabled under 65 (of whom 100,000 had already applied for it before enrollment was closed). In spite of Daniels’ oft-stated opposition to recent federal health reform legislation, the state now seeks to extend the waiver & then also use newly-available US health reform matching to implement required coverage of non-disabled adults under 133% by—or even before--2014. The insurance offers HMOs, preventive care, few co-pays; yet no dental or vision care —and patients must put 2%-4% of income into HSAs. See “Healthy IN..” at
www.kff.org & “Profiles: Healthy IN…” at
www.statecoverage.net . Daniels plans to cut provider fees 5%. The state Supreme Ct rejected an ACLU class action suit to make the state more proactively consider other possible impairments in Medicaid disability eligibility determinations.
Iowa--A waiver covers both I/P & O/P care and Rx’s (but only at 2 safety net hospitals) for non-Medicare adults—even if childless & non-disabled—under 200%/250% if wkg,. The state is considering seeking CMS approval to expand the waiver to let patients get care at any low income clinic and (at least) emergency care at any hospital in the state. The aged/disabled level is $674/mo (the SSI rate), the parent level is 28%/ 83% if wkg (‘10) & ADAP’s is 200%. The risk pool has a Medicare supplement but no low income premium discount. The 2011deficit is $116 million. Gov. Culver & the legislature (both D) covered disabled children under 300% via the FOA, raised the CHIP level from 200 to 300% & let children without dental coverage buy into CHIP dental benefits only. Iowa hospitals are proposing a plan to tax them-selves $40 million to attract enough added US matching funds to raise their own rates and also fund other rising Medicaid costs. There’s an ADAP waiting list of 118 (but the state just got an extra $664,000 in US funds) & its formulary was cut.
Kansas---this Title XVI state has an aged/disabled level of $674/mo (the SSI rate), a parent level of 26%/32% if wkg (‘10), a 200% CHIP level & a 300% ADAP level. Blue Cross & a foundation subsidize insurance for KC-area families under $30,000. The risk pool has no low income premium discount & bans Medicare eligibles. The legislature (R) cover-ed the working disabled, offered state mini-COBRA rights, raised CHIP’s level to 250%--but wouldn’t fund already-auth-orized adult coverage expansions, an adequate eligibility staff budget or more workers to cut a backlog of 12,000 applica-tions. There are 5,700 on waiting lists for services for phys disabled & DD clients, yet it cut in-home care funding for the aged & disabled; put 6,000 more on waiting lists for HCB & in-home care; cut MD fees & pay for disabled clients’ care-givers 10%; ended welfare for 1,500 awaiting SSA disability awards; denied dental care to poor women; raised CHIP pre-miums $10 to $20/mo; and froze admission to 3 overcrowded state mental hospitals. With a $219 million total state deficit & a $41 million Medicaid & human services shortfall for 2011, Gov. Parkinson (D) seeks to start a case manager program to oversee psychiatric Rx therapy & proposed a 1 cent sales tax raise--while the state’s hospitals favor a tobacco tax boost & the nursing homes offered to tax themselves, with each of those 2 taxes’ proceeds to then be used to attract more US matching to raise both those providers’ respective rates. The 3 taxes, if passed, could prevent more cuts from being consi-dered--such as requiring more pre-authorization & co-pays for un-needed ER visits & cutting state DD facility admissions
Kentucky--- has an aged/disabled level of $674/mo (the SSI rate), a parent level of 36%/62% if wkg (‘10), a 200% CHIP level & a 300% ADAP level. The legislature (R Sen.; D House) dropped tough, yet unworkable, nursing home & HCB medical admission rules; capped Rx’s at 4/mo, limited occu, phys & speech therapy, x-rays & MRIs; raised co-pays; and divided Medicaid’s patients into 4 groups that can get different benefits: healthy adults; children; aged & disabled; and MR & DD patients. The risk .pool has no low income premium discount or Medicare supplement. Gov. Brash-ear (D) faces deficits of $257 million in 2011 & $751 million in 2012, with Medicaid & CHIP costs swollen $242.5 mil-lion but says he’ll save Medicaid $108 million in 2010-11 with more efficiencies & anti-smoking benefit, with no service or cov-erage cuts. He boosted CHIP outreach, enrolled 22,000 more children & dropped its $20 premium. There’s a 251-person ADAP waiting list (but it just got an extra $1.76 million in US funds), co-pays are now required & the formulary was cut
Louisiana---has an aged/disabled level of $674/mo (the SSI rate), a parent level of 11%/25% if wkg (‘10) & a 300% ADAP level. Its risk pool has no low income discount & bans Medicare eligibles. The legislature (D) voted to raise the CHIP 250% level to 300% but can’t afford to. Gov. Jindal (R) covered the working disabled, got CMS to agree to a state refund of only $266 million for past overpayment, sought a waiver to cover parents below 50% in the 3 biggest cities plus all adults under 200% in Lake Charles & asked that $30 million/yr in expiring US primary clinic grants be continued. The state plans to cut $268 million+ by lowering covered Rx’s from 8 to 5 /mo (unless more are “medically justified”) and slashing MD & hospital rates and funds for—and privatizing--community services & HCB waiver care for aged, CMI, DD & physically disabled clients. US matching will fall $700 million in 2011, 2012’s deficit is $1.5 billion & LA plans $340 million more in provider fee cuts. FEMA will pay $478 million to rebuild the N. O. State Charity Hosp, to which the state will add $300 million. But it also must find another $70-100 million/yr to fund its operation (even though it already lacks money to keep 4 to 6 of the LSU & charity hospitals open). ADAP’s $11.7 million shortfall required shifting $2 mil-lion from other HIV accounts to it (yet there’s still a waiting list of 308, but it just got an extra $1.06 million in US funds).
Maine---Gov. Baldacci & the legislature (both D) set these income levels: subsidized health insurance, 300% (with up to $8 million more in premium subsidies now available even for part-timers); the aged & disabled, 100% (with a $75, not just $20, disregard); childless, non-disabled adults, 100% (a waiver that’s now taking up to 2,000 new patients); parents, 200% /206% if wkg; ADAP, 500%; CHIP, 200%; the SPAP, $1,604 /mo for 1 & $2,159/mo for 2; and 250% for O/P-only waiver care for HIV+ (even “pre-disabled”) patients. There’s no risk pool. Baldacci favors an employer play or pay rule, reforming hospital funding & starting risk pool & reinsurance plans. Adult dentistry covers little but dentures. There are no MSP asset tests & QMB’s income level is 150%, SLMB’s is 170% & QI’s is 185%. With a $100 million 2011 defi-cit, he raised cost-sharing for those over 150%, cut podiatry services & provider fees & may start an ADAP waiting list
Maryland---has an aged/disabled level of only $674/mo (the SSI rate), a 300% CHIP level & a 500% ADAP level. An appeals court upheld an AARP/Legal Aid suit to widen the state’s too-strict nursing home, HCB waiver & at-home care medical qualification & appeal rules. A waiver merged the main SPAP & a state low income O/P clinic program into one O/P-only primary clinic care & Rx program for any & all non-Medicare adults (even the childless & non-disabled) under 116%. A state-sponsored, Blue Cross-run 2nd SPAP (with a 300% level) covers some Pt D donut hole & premium costs, but seems to exclude the disabled. A child’s untreated tooth infection killed him, so UnitedHealth funded an indigent child treatment clinic at the state dental school. The risk pool has low income premium discounts for those under 200%, but no Medicare supplement. Gov. O’Malley & the legislature (both D) covered the working disabled, raised the parent income level to 116% for full Medicaid & subsidize insurance for some low paid small firm workers. He cut Medicaid by $82+ million, including nursing home, home health aide, private RN & HMO fees & slashed hospital rates to 80% of private plans’. A $389 million 2011 deficit at first forced him to delay a 2nd expansion of full Medicaid to childless, non-disabled adults under 116%--but later said he will now implement that using newly-available US health reform matching funds. He cut $90 million more in health funding for provider fees, HMOs, HCB programs & personal aides for the disabled; and plans $300 million more in health cuts---including closing a state mental hospital & a $180 million nursing home fee cut .He & the homes hope to more than make that up with later rate increases that will be funded from a 2% tax they’ll pay which will attract more US Medicaid matching. He is funding a $42 million child dental fee raise; is carving children’s dental services out of HMO contracts for direct state managing; and made hospitals give free care to those under 150%.
Massachusetts---has no risk pool. Ex-Gov. Romney (R) & the legislature’s (D) expanded Medicaid; required everyone to have insurance; subsidized it for those under 300%; boosted the CHIP level from 200 to 400%; raised the parent & child-less disabled Medicaid levels to 133% but kept the childless ageds’ at only 100%. The ADAP level is 488% & the SPAP’s is 188% (but up to 500% for Pt D patients). Gov. Patrick (D), with a $2.5 billion 2012 deficit, raised subsidized insurance, Medicaid & SPAP cost-sharing; proposed freezing MD & hospital fees; cut funds for substance abuse, tobacco cessation, school RNs & birth control; restricted legal aliens to limited I/P hospital care & a contract PPO network (advocates say it has too few providers); proposed confining adult denture & root canal service to community health centers; raising MD & Rx co-pays (even for generics); requiring prior approval of costly psychiatric Rx’s; ending personal aide care for those getting it under 15 hrs/wk; cutting hospital fees; and requiring college students to be insured. He seeks $331 million in US funds to meet shortfalls at 7 safety net hospitals. The legislature is considering forcing aged dual eligibles into HMOs
Michigan---has no risk pool; an aged/disabled level of 100%, a parent level of 37%/64% if wkg (‘10), a CHIP level of 200% & a 450% ADAP level. It ended adult dental (but after an untreated tooth infection killed a patient, a suit was filed to bar the cut), hearing aid, podiatry & chiropractic coverage & briefly closed enrollment in its O/P care-only waiver for childless, non-disabled adults under 35%/45% if wkg. The old GOP legislature raised co-pays but raised child wellness, dental & adult preventive fees. The Flint, Lansing, Muskegon & Detroit-area counties offer coverage to those under 200% and Oakland Co. may do so too. With a $480 million 2011-12 deficit & a ½ million added Medicaid patients just in 2009, the House (now D) & Senate (still R) cut MD, hospital & mental health fees $165 million & ended adult vision care--and now must make even more cuts The Senate killed Gov. Granholm’s (D) plans for a 3% MD & other minor taxes to avert cuts; and its leaders favor dropping some mental health care & “optional” services and coverage of childless, non-disabled 18-to-21-year-olds. Advocates are demanding, and may sue to require, wider autism coverage in Medicaid & private plans
Minnesota---this 209(b) state has an aged/disabled level of 100%, a regular, full Medicaid parent level of 215%/ 219% if wkg (‘10), a CHIP level of 275%, an ADAP level of 300% & a risk pool with low income premium discounts for those under 200% & a Medicare supplement. With a projected $6 billion 2011-12 deficit, Gov. Pawlenty (R) raised premiums & co-pays for Medicaid, CHIP & Minnesota Care (state-subsidized insurance for parents under 275% & childless, non-disa-bled adults below 250%) and denied Medicaid & CHIP to legal aliens. He ended ADAP co-pays, covered the working disabled, yet cut hospital rates $90 million & MD fees 7%, & capped enrollment in HCB care. He proposed tightened medical qualifications for & cutting hours of home aides; cutting nursing home & HCB waiver care fees; raising some client premiums; ending coverage of occu & speech therapy and audiology; and dropping adult dentistry. He & the legis-lature (D) compromised to preserve a cheaper, barebones state Gen Med Asst (GMA) program for childless, at least par-tially disabled adults under 75% with stingy block grants totaling under ½ of GMA’s earlier budget for provider hospitals to care for them. Hennepin Co’s Med. Ctr can’t giving free care to other counties’ indigents & had to cut mental health dental & HIV services. At first, no non-Twin Cities hospitals became providers in the new GMA plan because the grants are far below the cost of care. Pawlenty & the legislature compromised again to authorize his successor, at his sole discre-tion, to move GMA patients into US-matched Medicaid, as now allowed by the US health reform law (which D’s favor, but R’s oppose). He then tried to boost the appeal of the new GMA grants to the hospitals--yet convinced only Hennepin & 3 others but still none at all outside the Twin Cities--by putting ceilings on the number of GMA patients each must take
Mississippi---has no spend down; its risk pool has no low income premium discounts or Medicare supplement. Gov. Bar-bour (R) cut the aged/disabled level from $1,000+ to $724 (with a $50, not just $20,disregard). The parent level is 24%/ 44% if wkg (‘10), CHIP’s is 200% & ADAP’s is 400%. Only 2 brand Rx’s & 3 generics/mo are allowed (HIV patients get 5 brand Rx’s). Barbour cut phys, speech & occu therapy benefits and an in-person re-application rule limits enrollment; he & the Senate (D) won’t drop it, except maybe for LTC clients, while the House (also D) would do so. After securing new cigarette & hospital taxes, Barbour dropped his earlier MD, DDS, druggist, nursing home & hospital fee cuts; but may add premiums & raise co-pays; cut subsidies for mental health centers, proposed closing 4 mental hospitals & 15 mental crisis centers and opposes using state reserve funds & even further enhanced US matching to bolster Medicaid (which is short $34 million). Some disabled children’s parents say the state has tightened Katie Becket waiver medical qualification rules
Missouri---is a 209(b) state. Its risk pool has no Medicare supplement but has a low income premium discount (and the pool director has called for even more affordable premiums). The GOP legislature cut the aged/disabled level from 100 to 85%; ended medical assistance for those awaiting SSA disability awards; cut the parent level to 19%/ 25% if wkg (‘10); ended adult dental coverage; raised CHIP premiums; denied CHIP to those whose job plans cost under 5% of income (with exceptions); raised & more strictly enforced co-pays; but kept the ADAP & CHIP levels at 300% & raised the SPAP (which covers those disabled on Medicare) level to 150%. Blue Cross & a foundation subsidize insurance for KC-area families under $30,000. The state uses “premium support” to pay clients’ job plan premiums rather than give them full secondary Medicaid; restored hospice & working disabled coverage (but the latter covers only those with very low SSDI awards); gave birth control & screenings to women under 185%; restored adult vision (except for the aged in nursing homes), hearing aid & podiatry benefits; and let the aged & disabled opt out of HMOs. A court made the state widen notice & hearing rights before CHIP terminations; and the state lets clinics enroll children. Gov. Nixon (D) asked the still-GOP legislature to partially restore the former 100% parent level (only to 50%, but it refused even that); cover all adult dental, hearing & vision care (also rejected); and liberalize CHIP premiums & coverage (killed too). A caseload grown by 40,000+ since 1/09 forced Nixon to drop plans to restore the 100% aged/disabled level & do more enrollment outreach (in fact, new red tape instead now impedes enrollment). He sought cuts of $139 million in hospital rates & $32 million in MD & DDS fees and in mental health & public clinic funding; and did cut the ADAP formulary. The legislature made private plans cover some autism care. CMS said the state home health benefit is improperly limited only to homebound patients
Montana---has an aged/disabled level of $674/mo (the SSI rate), a parent level of 32%/56% if wkg (‘10), an ADAP level of 330% & a risk pool with low income premium discounts for those under 150% & a Medicare supplement. 2011’s defi-cit is $201 million, so the state raised cost-sharing and cut LTC & hospice benefits & access and aged/disabled MD visits to 10/yr. But Gov Schweitzer (D) & the legislature (R Sen; tied House) ended a CHIP waiting list (yet ADAP has one for 10, although it’s getting $131,000 in extra US funds); seek a waiver to cover more adults; raised the family asset level; has a SPAP for Medicare patients under 200%; widened CHIP dental & preventive care; and made private plans offer vaccin-ation & well-child care to age 7. A referendum raised the CHIP level (a 2nd time) to 250% but child enrollment has slowed
Nebraska---is a Title XVI state with a one-house “non-partisan” legislature. Its aged/disabled level is 100%, its parent le-vel is 47%/58% if wkg (‘10), its CHIP level is 185% & ADAP’s is 200%. It ended Medicaid for many parents who chose to leave welfare for work, but the state Supreme Ct forbade denying Medicaid to those who don’t meet work mandates. The risk pool has a Medicare supplement but no low income premium discount. Gov Heineman (R) covered Pt. D co-pays for HCB & group home clients & raised CHIP’s 185% level to 200%. With a $340 million 2012 deficit, he may cut provi-der fees, limit dental care to $1,000/yr, hearing aids to 1 per 4 yrs, eyeglasses to 1 per 2 yrs & adults to 12 chiropractic vi-sits & 60 occu, speech & phys therapy sessions/yr. An ADAP waiting list ended but its formulary was cut. When the state Medicaid program stopped covering pregnant aliens (even legal ones) & their fetuses, the U of NE Med Ctr covered them in its own indigent program. The state widened school-based health services & reversed 79 service denials to the disabled.
Nevada---a Title XVI state with no spend down & no risk pool (and the state won’t run its own US health reform-funded risk pool); its disabled level is $674/mo (the SSI rate), while the aged-only level is $710.40 (their SSI/SSP rate); its regular Medicaid parent level is 25%/88% if wkg (‘10); its CHIP level is 200%; its ADAP level is 400%. It subsidizes insurance for parents under 200% working for participating small firms and covers the working disabled. Its SPAP, with a 225% level, covers the disabled and even offers a vision benefit; but the state raised CHIP premiums---which Gov. Gib-bons (R) now wants to triple. With an $88.5 billion 2011 deficit he & legislature (D) capped CHIP dentistry at $600/yr; ended CHIP orthodontia & vision care; tightened SNF, ICF, HCB waiver & home care qualification rules, cut pregnancy coverage, hospital rates (closing the U of NV.at Las Vegas Hospital’s dialysis & oncology clinics), HCB waiver fees & attendant funds for the disabled; limited non-emergency transportation and cut hospital neonatal & pediatric specialist fees. The HIV agency cut its Las Vegas-area budget $1 million & rising numbers of indigents are saddling the state’s low income clinics with big budget shortfalls. The state set up a preferred list of anti-psychotic, anticonvulsant & diabetic Rx’s
New Hampshire---a 209(b) state; its a risk pool has no Medicare supplement but recently added low income premium discounts for those under 250%. Its aged/disabled level is $714 (the SSI/SSP rate; but the disregard is $13, not $20/mo), its parent level is 39%/49% if wkg (‘10), and the CHIP & ADAP levels are 300%. The state has a much-stricter-than-SSI “209(b)” Medicaid disability rule (inability to work for over 4 years) & doesn’t cover hospices. Gov. Lynch & the legisla-ture (both D) shifted some LTC costs to counties, ended a DD care wait list & let 19-to-26-yr-olds buy into CHIP. He & the legislature are making more cuts in hospital, MD, LTC & mental health fees (at first, 2011’s deficit was to be $75 mil-lion). US auditors want $35 million in over-claimed DSH funds back & 2010 Medicaid costs ran $43 million over budget
New Jersey---has no risk pool, an aged/disabled level of 100%; an ADAP level that Gov. Christie (R) is lowering from 500% to 300% (ending Rx coverage for 957 clients, although it just got an extra $642,000 in US funds) and SPAP levels of $31,850 for 1 & $36,791 for 2.; A waiver covers others (even childless & non-disabled) under 100%. The legislature (D) required coverage of all children & raised the parent level to 200%. Public Citizen said NJ’s provider fees were the US’ lowest, so it raised many pediatric rates. One audit questions $52 million in school health costs, and a 2nd said hospi-tal indigency programs fail to collect millions from other liable payers. A court barred an assisted living facility chain from refusing to let patients remain using Medicaid when their own funds run out--but the practice continues. With an $11 billion 2011 deficit, the state cut hospital charity & teaching, day health center and township indigent care funding; cut the SPAP formulary & raised its co-pays--but boosted MD fees & low income clinic funding & ended CHIP premiums for those under 200%. Christie also seeks to drop adult aliens (even legal ones) & freeze parent enrollment, but the legislature (D) killed his plans to raise SPAP brand name Rx co-pays from $7 to $15 & require $310/yr deductibles--yet he still plans to cut funding for women’s & infants’ reproductive & health services (even for cervical & breast cancer screening)
New Mexico—has no spend down, but has a risk pool with a Medicare supplement & low income premium discounts for those under 400%. Its aged/disabled level is only $674/mo (the SSI rate), its parent level is 29%/67% if wkg (‘10), CHIP’s is 235% & ADAP’s is 400%. A waiver—which is again closed to new individual applicants, but not to small employer groups---heavily subsidizes insurance of any adult (even if childless or non-disabled) under 200%/250% if wkg. The state still refuses to process disability-based Medicaid-only applications from those whose disability hasn’t yet been approved by SSA--contrary to what’s long been a federal requirement--no matter how much they need medical care. Medicaid’s shortfall may be $300 million by 1/11 (it’s $40 million now), so Gov. Richardson & the legislature (both D) dropped prior eligibility expansion plans; and may end adult dental, vision, hearing aid & hospice coverage; slash phys, occu & speech therapy; cut mental health/substance abuse benefits & fees; and cut or even drop Rx coverage and HCB waiver services.
New York---has no risk pool. A waiver covers parents & couples (even if childless) under 150%, and childless (even non-disabled) single adults under 65 below 100% (but the level’s only $767/mo for childless aged singles). ADAP’s level is 431%. The state subsidizes insurance for workers under 250%, but caps Rx benefits at $3,000/yr. The legislature (D) still excludes the disabled from the SPAP (which has a 350%+ level); won’t cover digital mammograms; raised Rx & MD co-pays (but capped them at $200/yr); adopted a loose formulary; covers assisted living, chore aide & adult day care; makes counties pay ½ of state Medicaid costs (but caps their cost increases at 3.5%/yr); lets providers deny services to those who don’t meet co-pays; funded HIV day health care; covered colon & prostate cancer patients & working disabled below 250%; required hospital discounts for those under 300% & forbade taking debtor homes; passed mental health parity; and raised the CHIP level from 250 to 400%. With a $1.1 billion 2011 deficit, Gov. Paterson (D) signed a $1 billion hospital & nursing home fee cut; started a discount Rx plan for near-poor disabled; raised all Medicaid asset levels ($13,050 for 1, $19,200 for 2, etc); ended MSP & SPAP asset tests; extended all COBRA rights to 36 mos; proposed raising all adult lev-els to 200% when it’s affordable; but sought to cut Medicaid & mental health $471 million more, slash HIV care $6 mil-lion, force NYC HIV patients & all dual-eligibles into HMOs, proposed a $65 million group home cut (yet a US judge then ordered the state to move 4,300 mentally ill into smaller, better facilities) and signed a bill with $775 million in health cuts that also requires saving $300 million more in each coming year from “waste, fraud & abuse”, pares $72 mil-lion from low income health programs & makes big hospital fee cuts; but didn’t include most proposed SPAP cuts (except for adding red tape, in some situations, for SPAP coverage of Rx’s not covered by Pt D plans). Short $316 million, NYC’s public hospitals plan to cut child mental health & O/P Rx benefits and close some clinics. The City also proposed to end its school dental program & cut HIV services $17 million; its Council de-funded a health insurance advocacy program; and its safety net St. Vincent’s Hospital had to close. Paterson had earlier proposed cutting NYC public hospital subsidies $370 million and Mayor Bloomberg proposes eliminating 146 to 182 school nurse jobs. Paterson & the legislature raised tobacco taxes $1.60-a-pack to meet health costs & made private insurance plans cover more autism-related care
North Carolina---covers the wkg disabled, but allows only 8 Rx’s a month (plus another 3 or more on an exception bas-is).Its aged/disabled level is 100%; its parent level is 36%/49% if wkg (‘10) & its CHIP level is 200% (the deficit now prevents raising it). The SPAP– which excluded the disabled & ceased operating in 3/10, but may be re-started after 1//11 —subsidized Pt. D premiums for those under 175% not on full Extra Help. The legislature (D) set up a 2nd SPAP for ADAP clients on Medicare under 175% but ineligible for Pt D full Extra Help & passed limited mental health parity. It started a risk pool that excludes Medicare patients, requires pre-authorization & has a $250 co-pay for “specialty” Rx’s & a $100,000/yr out-of-pocket cap, but has low income premium discounts. A $1.2 billion 2011 deficit moved Gov. Perdue (D) to seek $30 million in drug maker rebates by starting a preferred Rx list (she later added some psychiatric Rx’s to it); to propose closing 50 state mental hospital beds & cutting MD, hospital, personal aide (plus limiting aide care to 18hrs/ wk), adult dentistry, mental health & community mental health funding (the last by $250 million, but she later agreed to restore $40 million of it). The budget cuts audiology, speech, phys & occu therapy & hospice funding and ADAP by $3 million (causing a waiting list that briefly hit 811, a formulary cut limiting coverage to Tier 1 Rx’s & a drop of ADAP’s level from 300 to 125%). It ends a Medicaid HIV case manager program & coverage of community-based rehab care and many child dental X-rays & sealants; limits diabetic supplies to 1 provider; and requires prior approval of X-rays, MRIs, MRAs, PET scans, ultrasounds & some EPSDT services. 2011’s Medicaid shortfall is $475 million. The state later found $14.1 million more for ADAP, which cut its waiting list to “only” 196 (and then it got an extra $2.24 million in US funds)
North Dakota---this 209(b) state has a risk pool with a Medicare supplement with no low income premium discount. Its aged/disabled level is $750, its parent level is 34%/59% if wkg (‘10) but the ADAP level was cut from 400 to 300%. Gov. Hoeven (R) covered disabled children under 200% via the FOA, boosted the CHIP level to 150% & raised the medically needy/spend down level. But the legislature (R) refused to again raise the CHIP level (to 200%) and cut ADAP’s formu-lary, capped its costs & enrollment and limited patient access to Fuzeon (but it then got an extra $65,000 in US funds).
Ohio--this 209(b) state with no risk pool has a parent level of 90% and cut the ADAP level from 500 to 300% (disenroll-ing 257 clients & triggering a waiting list of 148---and maybe imposition of Rx co-pays, although it just got an extra $1.23 million in US funds). It slashed adult dental funds 50%; cut secondary fees for dual eligibles & medical assistance for those awaiting SSA disability awards; moved most patients into HMOs (some with too few specialists); let providers turn away those who don’t meet co-pays; and passed mental health parity. Yet its aged/disabled level is only $589/mo (the US’ very lowest). Gov. Strickland (D) & the legislature (R-Sen; D House) raised CHIP’s 200% level to 300% (effective only when a lawsuit is decided) & covered disabled children under 500% via the FOA. He got a waiver to cover assisted living & lets over-income children buy into CHIP. He cut eligibility funding & nursing home fees (but the legislature then partially restored the fees & bolstered home care benefits); can’t cover adult digital hearing aids until 6/11; cut Rx fees & community mental health funds; imposed Rx co-pays & a generics preference rule; delayed MD, DDS & hospital fee raises & fully restoring adult dental benefits and told nursing homes to pay for their patients’ phys therapy, wheelchairs & medical equip (which some homes can’t or won’t cover, so some patients may not get needed care or equip). He moved 592 from waiting lists into HCB waiver care & signed bills imposing $718 million in “fees” on hospitals (with proceeds to be used to attract more US matching, with which to then raise rates) & extending mini-COBRA rights to small firms.
Oklahoma---this 209(b) state has a risk pool with no Medicare supplement or low income premium discount. It cut the aged/disabled level from 100% to $718 (the SSI/SSP rate). The parent level is 31%/47% if wkg (‘10) & ADAP’s is 200%. It abolished its parents & children spend down, has a 3-Rx’s/mo limit & doesn’t cover hospices. Gov. Henry (D) covered the breast/cervical cancer & working disabled groups and a waiver subsidizes insurance for students, the unemployed and workers & spouses in participating small firms under 200%. Employer eligibility was later widened & the legislature (R) cut plan premiums--but its benefits too.) It let Medicaid to cover assisted living; raised CHIP’s level from 185 to 300%; encouraged HSAs in employer plans; and gutted the insurance minimum benefits law. The ADAP adopted economies. With a $26.6 million Medicaid budget cut, the state may drop coverage of pregnant women’s dentistry, durable medical equipt & nebulizors and cut dialysis, diabetic supply, hospital, MD & nursing home fees; and raised co-pays. It seeks to limit ER visits to 3/yr; cut mental health $16 million (affecting 55,000 patients) and is closing 200 state mental hospital beds; cut covered brand name Rx’s from 3 to only 2/mo; ended coverage of speech, physical & other O/P therapies. The legislature enacted a 1% “fee” on paid health claims to raise $78 million (that could grow to total $250 million with the added US matching it can attract) to meet rising Medicaid & insurance subsidy costs--but the state’s own Insurance Cmr filed suit against it & got the state Supreme Ct to void the measure as violating strict state constitutional limits on tax bills
Oregon---this Title XVI state’s risk pool has no Medicare supplement but has low income premium discounts for those under 185%. Income levels are $674/mo for aged & disabled (the SSI rate), a 32%/40% if wkg for parents (‘10), 185% for an insurance subsidy for non-Medicare adults (with enrollment closed) & 200% for ADAP. An anti-tax referendum cut eligibility & adult dentistry and ended adult vision care. With a $577 million 2011 deficit, the OR Health Plan expansion waiver--with limited benefits for all non-Medicare adults under 100%--again froze enrollment. ADAP has cost-sharing, with a waiting list & formulary cut also possible. Gov Kungoloski & the legislature (both D) took the FOA option & pass-ed insurer & hospital taxes--upheld in a referendum that raised taxes on the rich too--to cover 80,000 more children (rais-ing CHIP’s level to 300%) 35,000 more adults & more in-home care (yet he later had to end home care for 100s of cases)
Pennsylvania---has no risk pool, an aged/disabled level of 100%, a parent level of 26%/34% if wkg (‘10), a CHIP level of 300% & an ADAP level of 350%. It subsidizes a barebones “AdultBasic” insurance (with no mental health or Rx benefits; the 390,000 on its waiting list can buy similar private coverage for $600/mo; but AdultBasic’s own increasingly costly cli-entele required imposition of $20 MD visit co-pays & a $1,000/yr hospital care cap) for non-Medicare adults under 208% /213% if wkg. Gov. Rendell (D) covered the working disabled, raised the SPAP’s levels (to $23,500 for 1 & $31,500 for 2, enough to cover 90,000 more aged, but it still won’t cover the disabled), applied 9 month state mini-COBRA rights to small firms & sought a $106 million hospital rate cut. But Senate (R) leaders want much deeper cuts & proposed freezing CHIP funding. Public Citizen says PA MD fees are the US’ 5th lowest. The 2011 deficit is $848 billion. A shortfall forced Phila city clinics to start charging fees of $5 to $20 & close some sites. The House (D) twice voted to widen AdultBasic (to cover 85,000 more persons and add Rx & mental health benefits) but Senate leaders continue to block any expansion. The state plans to offer a $300/mo premium discount to those under 200% in its US health reform-funded high risk pool.
Puerto Rico----its matching rate is capped far below what states get. Its ADAP income level is 200%. ADAP reviews & audits report inadequacies in care & fiscal irregularities. A key advocate has said there’s a 526-person ADAP waiting list
Rhode Island---has no risk pool & these income levels: aged/disabled,100%, parents, 175%/181% if wkg, CHIP, 250% & ADAP, 400%. It covers the working disabled & its limited formulary SPAP covers the aged but only those disabled over age 55 (with levels of $37,167 for 1 & $42,476 for 2). Gov. Carcieri (R) required free & discounted hospital care for those under 200% & 300% & banned taking debtors’ homes. Public Citizen says MD fees are the US’ 3rd lowest. Big deficits ($107 million in 2011) moved him to get a waiver with extra up-front US funding that in exchange requires the state to divert 12% of nursing home cases to cheaper home care & puts a cap on future US funds. See“RI’s Medicaid Proposal...” at
www.cbpp.org . The legislature (D) raised adult daycare co-pays and also dropped legal alien children & 7,400 parents.
South Carolina---has no spend down. Its aged/disabled level is 100% & its parent level is 48%/89% if wkg (‘10). It cut
its ADAP level to 300%. Its risk pool has a Medicare supplement but no low income premium discount. Gov. Sanford &
the legislature (both R) limited Rx’s to 4/mo & raised CHIP’s level to 200% (but he then proposed closing enrollment).
The SPAP level is 200%, but it excudes the disabled. With enrollment up 90,000 since 2007, the state cut Medicaid ment-
al health benefits, closed an HIV program to new clients & slashed home health, hospital & nursing home fees--yet passed
private plan mental health parity & a tobacco tax increase to bolster Medicaid that Sanford then vetoed. The House, but
not yet the Senate, voted to override the veto (yet it also voted to cut SPAP funds). The state ended its own ADAP funding
(even with a waiting list of 288, although it just got an extra $1.54 million in US funds), cut home care for the disabled &
Rx coverage from 4 to 3/mo, de-funded cancer screening and, advocates say, has been slowing enrollment with red tape.
South Dakota---has no spend down & a risk pool with no low income premium discount that excludes Medicare patients. Its aged/disabled level is $674/mo (the SSI rate), its parent level is 52% (‘10) & ADAP’s is 300%. Rejecting a call for ex-pansion, Gov. Rounds & the legislature (both R) refused to raise the pregnant woman & CHIP levels to 250% or provider fees and ended adult dentistry. There’s an ADAP waiting list of 25 (but the state just got an extra $29,000 in US funds)
Tennessee----Gov. Bredeson (D) & the legislature (R) set the aged/disabled level at $674/mo (the SSI rate), the parent level at 70%/129% if wkg (‘10) & ADAP’s at 300%. Except for the pregnant, children & HIV+ patients, MD visits were cut to 10/yr, hosp days to 20/yr & Rx’s to 2 brand name drugs + 3 generics/mo, except for some grave conditions. There’s a 250% CHIP level, a risk pool (with no Medicare supplement but with a premium discount for those below 250%), a SPAP (with a waiting list & low benefits cap) covering up to 5 generics/mo for non-Medicare patients under 250% & subsidized barebones insurance for non-Medicare adults under $55,000 (enrollment is closed). CHIP uses Medicaid Rx rules, but also covers diabetic items & more psychiatric Rx’s. Home care & medical equip benefits were cut. Deficit-pre-vention budgeting forced closure of 600 mental hosp beds, big mental health cuts & a $500 million hosp rate cut—causing short-falls at Nashville Gen Hosp (which then had to deny non-emergency care to indigent illegals) & Memphis Reg Med Ctr (though the latter was then bolstered with a $30 million US/state grant). Bredeson deferred caps on MD visits, trans-port & transplant care, kept a $10,000/yr benefits cap; curtailed occup, speech & physical therapy benefits and capped X-ray & lab usage and ADAP costs. A court voided its 1987 order grandfathering-in 150,000 ex-SSI recipients to Medicaid (almost all of whom were then found ineligible under today’s regular rules); see “Daniels Case” at
www.tnjustice.org Texas—has a risk pool with a Medicare supplement & but no low income premium discount .The aged/disabled level is $674/mo (the SSI rate), the parent level is 12%/26% if wkg (‘10) & the ADAP & CHIP levels are 200%. Gov. Perry & the legislature (both R) dropped coverage of CHIP prostheses, physical therapy & private duty nursing; raised CHIP co-pays & premiums; cut Medicaid home health; ended adult chiropractic & podiatry care; capped the number of Rx’s covered/mo ;moved patients into HMOs; contracted-out eligibility work to what some say are sub par contractors--but restored Medic-aid mental health, vision & hearing aid coverage and CHIP mental health & dentistry (Medicaid covers limited adult den-tistry too); required some mental health parity in private plans; and set up a SPAP for HIV clients. A non-profit agency (
www.TexHealthCoalition.org) fosters subsidized discount health plans for workers under 300% in small firms in the Bra-zos Valley, Dallas, El Paso, Ft. Worth, Galveston & Houston areas. A court order to improve children’s care & EPSDT requires raising MD & DDS fees (but budget shortages now require all provider fees to be cut); the 2011 deficit is $1.3 billion (due in part to 350,000 new Medicaid patients in 2009-10); and the legislature cut the Children with Special Health Needs program--plus a cystic fibrosis aid program for all ages--by $3.5 million (even with 950 children on a waiting list).
Utah—is a Title XVI state with a risk pool that has a low income premium discount, but no Medicare supplement. Its aged/disabled level is now 100%, its parent level is 38%/44% if wkg (‘10) & CHIP’s is 200%. A waiver—now closed to new enrollees--gives limited O/P care, with big co-pays, to non-Medicare adults (even if childless & non-disabled) under 150%. The legislature (R) stopped covering podiatry, audiology, speech therapy, chiropractic, outdoor wheelchairs and adult eyeglasses & dentistry (one patient’s untreated tooth infection spread to her brain & killed her); cut hospital & DDS fees 25%; but subsidizes insurance premiums for small firm workers under 150% (see “New CHIP /UPP Waiver..” at
www.healthpolicyproject.org) A legislative reform panel called for gutting the minimum benefits law & banning preexist-ing condition rules; and urging employers to offer HSAs instead of regular insurance--and the state let insurers sell cheap-er-than-COBRA policies. Gov. Herbert (R) restored dental care for children & pregnant women and some phys & occu therapy. Yet he & the legislature cut DDS fees further (which CMS disapproved); have an ADAP waiting list of 139 and cut its formulary & income level (to 250%, disenrolling 89 clients), yet it just got $724,000 more in US funds; closed en-rollment in Gen Asst welfare for those awaiting SSA disability awards (which then impedes access to already-hard-to-get Gen Medical Asst). They may cut the disabled level from 100 to 74%, school health funds & the pregnant woman asset level & drop the spend down. They’re considering a $23 million hospital tax to attract $50 million more in US matching.
Vermont—Its income levels are: aged/disabled, 100% & 110% (2 zones), parents, 185%/191% if wkg, childless, non-disabled adults, 150% /160% if wkg, CHIP, 300%, ADAP, 200% & the SPAP, 175%. The state subsidizes insurance for others under 300%. The legislature (D) voided Gov. Douglas’ (R) adult dental cuts (but dentures still aren’t covered & there’s a $495/yr cost cap per patient). A waiver, in return for more US funds, moves patients into HMOs & favors HCB care over nursing homes--but also caps future US matching funds. There’s no risk pool. The 2011 deficit is $9 million &
2011’s health/human services shortfall is $53 million. Douglas did pledge not to cut eligibility---and even recently signed a bill requiring more private insurance autism coverage--- yet he raised SPAP co-pays & seeks more cost-sharing (even though the legislature won’t consider raising CHIP premiums), a cap on allowed ER visits and provider & Rx fee cuts
Virginia---a 209(b) state with no risk pool. Its parent level is 23/29% if wkg (‘10), CHIP’s is 200% & ADAP’s is 400%. It covers the wkg disabled & has a SPAP for HIV+ Pt. D patients under 300%. With a big deficit, Gov. McDonnell & the House (both R) ignored less stringent Senate (D) proposals to slash provider fees & mental health community care funds, lower the $2,200/mo HCB waiver income level to $1,685 (even with a HCB waiting list of 6,000), and cut local mental health & substance abuse funds 5%, CHIP’s 200% level to 175% (which may turn away up to 28,000 children & pregnant women) and the 80% aged/disabled level to 75%. Tardy handling may endanger a US grant for indigent adult dental care.
Virgin Islands--its matching rate is far below what states get. Some say its ADAP (with a 400% level) has a waiting list.
Washington--its risk pool has a supplement open to some, but not all, Medicare patients & a low income premium discount for those under 300%. Its aged/disabled level is $720 (the SSI/SSP rate), its parent level is 37%/74% if wkg (‘10) but ADAP’s 300% level was cut to 275%. Gov. Gregoire & the legislature (both D) passed mental health parity. Facilities evicted 75+ assisted living clients due to paltry state fees. A $480 million 2011 deficit didn’t stop the state from raising CHIP’s 250% level to 300%. The state raised BasicHealth (its subsidized insurance for non-Medicare adults under 200%, with a waiting list of 100,000) premiums & co-pays; cut Gen Medical Asst (by $190 million, dropping 3,000 clients), DSH payments & nursing home fees; and limited drug, DME, imaging, denture, diabetic supplies, personal aide & home care hours, adult day care, maternity & infant case management & incontinence benefits and cut druggist, pediatric, HMO & day health center fees. It may drop adult eyeglasses, dentistry & colorectal cancer screening, yet may let over-income children buy into a CHIP-like plan. ADAP’s formulary was cut, cost-sharing was imposed & the Gov proposed a 25% cut in other HIV services (but it just got $102,000 more in US funds). The state was seeking insurer bids to sell a low-cost in-surance & is now exploring using newly-available US health reform matching to fund merging BasicHealth into Medicaid
West Virginia---has an aged/disabled level of $674/mo (the SSI rate), a parent level of 17%/33% if wkg (‘10) & a 250% ADAP level. It covers only 4 brand Rx’s/mo (+6 generics). Its risk pool has no Medicare supplement but low income premium discounts are now authorized. It denies all adult dental care but extractions & emergencies and didn’t properly adopt nursing home & HCB medical admission rules (which still impede access). Gov. Manchin & the legislature (both D) started an Rx aid plan for non-Medicare adults under 200%; but CMS is trying, over state objections, to halt a waiver that offers clients more mental health care & Rx’s--but only in exchange for adhering to “personal responsibility” pledges. Manchin raised the CHIP level to 250% but plans to herd the disabled into physical & mental health managed care and parents & children into dental & mental health managed care which dentists & advocates say reduce patient access to care
Wisconsin---has an aged/dis
