A budget impasse in Alabama is beginning to delay healthcare for children and Medicaid beneficiaries in the state.
This past spring, the state's Legislature overrode Gov. Robert Bentley's veto and appropriated $700 million to Alabama's Medicaid program. That was $85 million less than what the Republican governor had requested based on what the agency said it needed to maintain services. Bentley has called for a special session to approve a new funding measure.
Linda Lee, executive director of the Alabama Chapter of the American Academy of Pediatrics, said the patients she advocates for are already seeing longer waits after providers began to cut staff in anticipation of the cuts. As of May 2016, Alabama has enrolled 888,641, or nearly 20% of the state's population, into Medicaid and the Children's Health Insurance Program.
Residents of Alabama historically rank among the lowest in the nation in terms of some of the most pressing health conditions, including infant mortality. Any cuts to Medicaid might also jeopardize the state's efforts to change the program in ways health officials hope will improve healthcare.
"Alabama already runs the most bare-bones Medicaid program in the country," Mark Jackson, executive director of the Medical Association of the State of Alabama, said in a statement. "So to end this legislative session without an appropriate funding solution is more than heartbreaking, it's dangerous."
Alabama Medicaid Commissioner Stephanie Azar said the cuts may force her to limit Medicaid offerings to the bare essentials, which means dropping coverage for hospice, outpatient dialysis, prosthetics and orthotics, and medications for adults.
If Azar were to move forward with these changes, the CMS warns, it will rescind the state's recently approved 1115 waiver, which moves Alabama from the traditional fee-for-service delivery model to a managed-care model involving regional-care organizations, said Jim Carnes, policy director for Alabama Arise, a consumer advocacy organization. The state was expected to receive up to $748 million over the next five years under the waiver.
On Aug. 1, the agency ended a primary-care raise providers had received since 2013 as a way to entice more of them to take on Medicaid patients. The Affordable Care Act temporarily increased Medicaid reimbursement for primary-care services to match Medicare rates. The provision ended in 2014, but states had the option to continue it on their own.
Alabama's Medicaid agency is saving about $15 million by eliminating the raise. Providers say the move translates to a 30% cut in payment for basic care. As a result, practices already have been laying off staff. Others are expected to reduce the amount of Medicaid patients they will see. A few said they will close their doors all together.
Lee said she worries about how rural practices might be affected. "Children will see increased drive times to get care,” she said.
Danne Howard, executive vice president and chief policy officer for the Alabama Hospital Association, said she expects that will result in more patient visits to the emergency room.
Bentley called a special session to approve a referendum that would have voters weigh in on the creation of a state lottery that could bring in $225 million in annual state revenue.
But voters couldn't weigh in until the elections in November, and if it passed, revenue would not likely start coming in until fiscal 2018, Carnes said.
Numerous medical trade groups are hosting news conferences around the state every day this week to rally the state Legislature to address the budget gap.