State healthcare programs are increasingly under siege as states grapple with continuing deficits and try new means of keeping services for the most vulnerable populations, but beneficiaries and providers are bracing for new cutbacks.
Texas, which has been criticized for past cuts in benefits, actually increased its funding for Medicaid and the Children's Health Insurance Program, but Gov. Rick Perry also rolled out a new means test for CHIP that calls for determining a family's "additional assets" when deciding eligibility.
A fellow Republican, state Comptroller Carole Keeton Strayhorn, sent a letter to Perry requesting that he rescind the means test because it will jeopardize access to care for poor families. She added that families with $5,000 in savings could be disqualified. She said $934.3 million in unallocated state funds could be used to restore healthcare cuts made to offset a budget shortfall last year. Strayhorn also alleged that the governor shifted the salaries of four employees in his mansion along with five other staffers to another agency in order to reflect a $300,000 budget savings.
"If you can magically manage to keep two maids, a cook and a porter on your staff at the governor's mansion while claiming that they are not part of your budget, certainly you can figure out a way to continue insuring the health of these children," she wrote.
In Tennessee, Gov. Phil Bredesen unveiled a draft version of a plan to save the TennCare Medicaid program some $1 billion in the next four years through limiting services and prescriptions, adding copayments for some enrollees and ending notifications to enrollees when they've reached their monthly or yearly treatment limits
In Georgia, Gov. Sonny Perdue introduced a plan last week that would move about 1 million Medicaid enrollees into managed-care plans. A spokeswoman for the governor said the plan is in its infancy but cited cost-cutting as the reason behind it. Medicaid costs in the state are expected to consume 43% of new revenue for fiscal 2005, which started July 1, and 60% for fiscal 2011, according to the Georgia Department of Community Health. Later in the week, the department said it was considering cuts to health programs for low-income people and those with disabilities. In three budget alternatives the cuts ranged from $172.6 million to $327.6 million.
Enrollment in states' low-income insurance programs increased to 35.6 million last year, up 7% from 33.2 million in 2002, according to the latest census data released last week.
The increase has been driven by workers who no longer have employer-based insurance programs, according to an analysis of the census data by the Center on Budget and Policy Priorities, a nonpartisan think tank.
Edwin Park, a senior policy analyst for the center, said as states continue to deal with budget deficits by cutting Medicaid and low-income and disability programs, provider reimbursement cuts are inevitable. That could further complicate problems in such states as Illinois where low reimbursements have deterred doctors from serving Medicaid enrollees, leading a U.S. District Court judge in Chicago to find the state in violation of federal Medicaid laws for not providing adequate payments for services to Medicaid children.