Facing big state budget deficits, legislatures in at least 46 states have enacted laws to alter Medicaid eligibility, benefits and provider pay to balance program shortfalls, according to a new report from the National Conference of State Legislatures.
Thirty-eight states changed provider and service reimbursement rates, 36 states changed eligibility for enrollees and 37 states enacted changes affecting prescription drug benefits, the report finds.
Six states reduced or froze reimbursement for physicians, while eight states cut payments to nursing homes, 11 states reduced or froze payment to pharmacists, 11 states reduced payment to hospitals and three states cut or froze reimbursement for dentists.
"These tight budget times have unfortunately called for sacrifices," says NCSL President and Oklahoma state Sen. Angela Monson in a written statement. "Some Americans may have to pay a few more dollars for medication next year. Doctors may have to settle for level or lower fees. Patients will have to cover the costs of visits to the chiropractor or the dentist themselves. But by and large, this safety net is still pulled taut under vulnerable Americans."
Medicaid is the second-highest cost for states after education and accounts for about 20% of state budgets. The NCSL Health Policy Tracking Service surveyed legislative and executive actions in all 50 states that will affect changes in eligibility, co-payments, optional benefits and services, and provider and service reimbursement rates in the Medicaid programs in fiscal year 2004.
As of July 21, six states had yet to enact fiscal 2004 budgets: California, Connecticut, Michigan, New Hampshire, Oregon and Wisconsin.
Program cuts in other state programs and $10 million in federal assistance helped some legislatures avoid the drastic cuts they had predicted earlier this year. Yet 13 states decided to freeze or limit medical assistance programs, and several others made significant changes to eligibility in their state children's health insurance program (SCHIP.)