Patients Continue to Pay Price of Medicaid Cuts
Mississippi state legislators and officials have approved the“ deepest cut in Medicaid eligibility for senior citizens and the disabled that has ever been approved...,” according to a June 13 New York Times article.
That cut is one of a number of threats and damaging changes to the Medicaid program and to other mental health services by officials in various states, as reported by newspapers and other media during the last two months.
According to the Times, the new law in Mississippi has lowered the eligibility threshold from $12,569 to $6,768 for an individual to qualify for Medicaid.
The anticipated result is that 65,000 low-income seniors and people with disabilities will lose coverage.
Mississippi Gov. Haley Barbour (R) initiated the change, along with the state's Senate, according to the Times.
As of press time, some of the members of the Mississippi House were trying to undo the legislation.
Florida Moves to Managed Care
In Florida the state legislature has approved a bill (HB1843) that could result in the transfer of approximately 73,000 people with mental illness who receive treatment through Medicaid to health maintenance organizations.
An editorial in the Daytona Beach News-Journal on June 14 called the change “a gut-wrenching leap into the unknown for these patients, their families, and the community mental health organizations that serve them. The abrupt transition is unplanned for, unnecessary, and unjustified.”
The editorial points out that the Florida Substance Abuse and Mental Health Corporation Board, created in 2003, was asked to conduct a study of managed care and mental health, with a due date of December 2004.
Yet the shift to managed care is scheduled to take place on July 1.
Margo Adams, executive director of the Florida Psychiatric Society (FPS), told Psychiatric News that key issues concerning implementation remain unclear.
The FPS is working with NAMI-Florida and other advocacy organizations to“ try to make certain that the state moves carefully in its contracting process to ensure that the needs of people with serious mental illness are met.”
She expressed concern about problems resulting from the speed of the transition and said that the FPS is urging the state to allow stakeholder input. The FPS is preparing a background paper on issues related to the change.
Shortfall Hurts Illinois Providers
Aaron Chambers in the June 9 Rockford Register Star reported that Illinois was $900 million behind in payment of Medicaid bills at the end of May.
The backlog was expected to grow to $1.15 billion by June 30, if state officials could not secure a loan to meet the shortfall.
To help address the Medicaid shortfall, Gov. Rod Blagojevich (R) has proposed that providers of mental health services receive reimbursement on a fee-for-service model, rather than the existing grant-based system, whereby funds can be used for a variety of services.
The Illinois Department of Human Services is planning a test run of the fee-for-service model with 25 providers of mental health services.
ERs Swamped in Michigan
Gregg Krupa reported in the Detroit News on May 27 that St. John Hospital and Medical Center's emergency room (ER) in Detroit “has seen more than a 200 percent increase since 2002, from about 150 visits to about 500,” in admissions of people with mental illness.
Emergency room visits at the Beaumont Hospitals in Royal Oak and Troy are projected to increase by 10 percent.
People with mental illness who seek treatment in ERs account for a“ growing portion of the $1.2 billion in unpaid patient bills that hospitals in Michigan sustain each year,” wrote Krupa.
Andrew Wilson, M.D., chief of emergency medicine at the Beaumont Hospitals, told Krupa, “We are not set up to provide ongoing care, and what most psychiatric patients need is ongoing care.”
Observers attribute the problem, in part, to the state's erroneous assumption that private hospitals would fill the demand created by the closure of state hospitals.
According to the Michigan Psychiatric Society, in Wayne County the number of available hospital beds for mentally ill people declined by 60 percent to 310 during the last decade.
During the same period, the number of beds in Oakland County declined from 875 to 415.
According to the Detroit News article, the situation is even worse for children who need care.
The Kaiser Commission on Medicaid and the Uninsured in June issued the first substantive analysis of the impact of Medicaid budget cuts in Oregon. These are among its findings:
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Many of the people affected by the Medicaid waiver changes had very limited incomes and serious physical and mental health problems.
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People who lost coverage faced significant difficulties obtaining care.
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Medicaid reductions appeared to increase pressure on other parts of the health care system.
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Coverage reductions created short-term savings, but the savings resulted predominantly from reduced coverage and care.
A more extensive discussion of the report will appear in the next issue of Psychiatric News.
“The Impact of Recent Changes in Health Care Coverage for Low-Income People: A First Look at the Research Following Changes in Oregon's Medicaid Program” is posted online at<www.kff.org/medicaid/7100a.cfm>.▪
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Published online: 2 July 2004
Published in print: July 2, 2004
Notes
States continue to impose cuts to Medicaid, and their impact on access becomes obvious.
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