States are shrinking their healthcare programs for the poor to save money by eliminating services offered during the economically robust 1990s. So if you're an adult on Medicaid in Florida and you want dentures, you may soon be out of luck. Ditto if you get publicly financed home-based health care in Colorado and the state decides you're getting too many visits from caregivers. And if you live in Connecticut or Arkansas and you want a name-brand drug instead of a generic, the state may say "too bad."
Forty-one states have cut health programs and slashed benefits this year to reduce Medicaid programs. Among the cuts seen so far:
It's hard to estimate exactly how many people across the country will be affected by the cutbacks. But since Medicaid now covers 47 million people, some policy experts say the number could be huge.
"It will be easy to have more than one million people lose health coverage," said Leighton Ku, a senior health policy analyst at the Center on Budget and Policy Priorities , a left-leaning think tank on fiscal policies affecting low-income people.
The number of people losing or getting scaled-back benefits will likely be "much larger," Ku said.
How do states decide where to cut? Ku said states typically first freeze or cut how much they pay doctors, hospitals and nursing homes.
"States routinely (go after payment rates) to control costs because they usually update the rates anyway. It has the potential to save lots of money without having to cut health services and eligibility," he said.
Next, officials move on to what federal law declares "optional" servicesthings like vision services and dental care. States are also scaling back who is eligible for Medicaid, and in most cases are rolling back recent expansions for groups like low-income single parents.
Even though some health benefits are labeled "optional" by the government and are viewed as easy to cut, Ku said there may still be harmful repercussions. "When you cut back vision services, it may be hard for someone to find a job if he can't see or get his vision corrected. So it's still counterproductive," he said.
Florida Medicaid spokesperson Pat Glynn said making cuts to the program is not an easy decision. But officials "looked at ways to effectively save money without hamstringing the entire Medicaid program. Dental benefits unfortunately had to be cut," he said.
As of July 1, the state will no longer pay for adult dentures or preventive care, things like routine teeth cleanings. Glynn said it's hard to estimate how many people will be affected.
But the dental budget was cut from $24.5 million to $5.9 million. And in fiscal years 2000 to 2001, more than 77,000 adults out of 2 million total Medicaid patients got dental care.
What's the fallout so far? Glynn said the department hasn't really had any feedback. "It may be a little early to tell. We're not seeing people go to the emergency room and we've had a negligible response or reaction from providers or recipients," he said.
Florida Senator Burt Saunders, who chairs the Health, Aging and Long-Term Care committee and received a "Senator of the Year" award from the state's dental association, said he hasn't heard any complaints yet either. "We didn't really hear from dentists on the issue," he said.
Saunders said despite the figures reported in the press, the state really hasn't cut much at all. Officials spent $600 million in non-recurring revenues and put in place cost-savings programs for things like prescription drugs that will save an estimated $1 billion, he said.
Florida now has, for instance, what's known as a preferred drug list, which means Medicaid will only pay for drugs that are cost-effective and medically efficient (a decision that's made by an independent panel). Manufacturers whose drugs don't make the list can pay the state additional money (a supplemental rebate) to get their pharmaceuticals on the Medicaid-approved system.
If things look rough this yearin terms of how many people are losing health benefitsSaunders said next year will be even worse.
"We've done a pretty phenomenal job over the last few years not to hurt beneficiaries of Medicaid at this point. But we'll be doing some very serious thinking next year. It will be much more difficult next year quite frankly," he said.