[Nfbf-l] Medicaid 2011 HMOS rule

[Kirk]

Hello friends, this is a bit lengthy of a read, but very important for us to 
follow! Your friend in the cause, Kirk
Medicaid 2011: HMOs Rule
Senate leaders began rolling out a plan to transform the Medicaid system 
Tuesday with a threat: If Washington doesn't go along, Florida could give up 
billions of dollars in federal money and run the program itself. The plan, 
outlined during a special meeting in the Senate chambers, would shift 
hundreds of thousands of low-income Floridians into private managed-care 
plans. It would exempt certain people with disabilities, while also placing 
tough requirements on HMOs and shielding doctors from malpractice lawsuits 
when they treat Medicaid patients. ... But at least for now, the chances of 
the federal government giving such flexibility to Florida appear slim. The 
state already is in limbo because the federal government has raised 
questions and sought changes in a much more modest Medicaid pilot program 
that covers five counties (Saunders, 2/15). Health News 2/16/2011



Also Sharing..Kaiser Report 2/9/11

Lisa Huff says the state-funded Disability Lifeline program in Washington 
state has lived up to its name, helping her get counseling for depression, 
treatment for diabetes and support for her ultimate goal: getting a job.

But now the program for low-income, temporarily disabled residents is one of 
many on the chopping block in Washington, where lawmakers face stark choices 
in closing a projected shortfall of $4.6 billion in their next two-year 
budget, 2011-2013.

At risk are some of the very programs seen today as national models: A 
state-subsidized Basic Health insurance plan for low-income residents who 
don't qualify for federal help -- the first of its kind when it began 20 
years ago -- services that help the elderly and disabled stay out of nursing 
homes and insurance for 27,000 undocumented children.

Washington's quandary is shared by many states: Demand for health-related 
services is growing, voters don't want to raise taxes, payments to doctors, 
hospitals and clinics have already been reduced and states risk losing 
federal funds if they cut eligibility for the joint federal-state Medicaid 
health program for the poor and disabled.

Most states - including Washington - have cut services and budgets during 
the recession. But the pain isn't over, despite a strengthening economy. 
State revenues lag pre-recession levels -- and billions in temporary federal 
stimulus funding that helped many governors avoid deeper cuts dry up June 
30.

The next fiscal year is shaping up to be the worst since the Great 
Depression, says Michael Leachman of the Washington-based Center for Budget 
and Policy Priorities. The liberal think tank reports that 44 states and the 
District of Columbia project shortfalls totaling $125 billion for fiscal 
2012, which begins in July for most.

Governors have asked Congress and the White House for more flexibility on 
Medicaid.

Health and Human Services Secretary Kathleen Sebelius told them they can 
trim some optional services, such as dental care, and those with budget 
deficits can cut eligibility for non-disabled, non-pregnant adults above 133 
percent of the poverty line, which is $14,500 for an individual. Twenty-one 
states and the District of Columbia currently cover adults above that level.

Robert Ruvkun, a physician assistant at Rainier Park Medical Clinic, has 
helped Lisa Huff get her diabetes under control. (Photo by Rob Sumner for 
USA Today)

But Sebelius didn't give the governors authority to more sharply curtail 
eligibility, something many seek.

Because health and social service programs make up a large portion of most 
state budgets - behind only education - lawmakers are girding for another 
round of cuts affecting services for the uninsured, the sick, the disabled 
and the poor.

While Arizona's decision to stop paying for organ transplants for its 
Medicaid patients has garnered national headlines, other states are making 
tough budget choices.

Dying Medicaid patients in South Carolina, for example, will no longer be 
enrolled in hospice starting in February. California Medicaid patients could 
be limited to six prescriptions a month and 10 doctor visits a year. 
Democratic Gov. Jerry Brown has also proposed ending payment for adult day 
care programs that help keep people out of nursing homes.  More than 5,300 
people are on waiting lists for help in getting expensive, life-saving 
HIV/AIDS drugs from a federal-state program -- a 50 percent increase since 
October.  Meal programs for the elderly and home-bound are also slated for 
reduction or elimination in many states.

"No one wants to do these things," says Joe Antos of the conservative 
American Enterprise Institute. "But states are really in fiscal trouble," he 
says, partly because of health program costs, but also because they have not 
trimmed back their state pensions and benefits.

'Difficult Choices'

In Washington state, health care and social services represent nearly 
one-third of the state's general fund expenses; education accounts for about 
half.

 "So it really does fall on social services and health care," says Gov. 
Chris Gregoire, a Democrat. "Those are difficult choices. Do I cut health 
care to children or single adults?"

She warns that short-term budget cuts can raise long-term costs: "The 
dilemma is we are really not going to save any money doing this."

For Huff, the end of Disability Lifeline could make her diabetes medicine 
unaffordable. Untreated, the disease can lead to a host of expensive and 
life-threatening complications. "It's a slow process, but it can kill you," 
says Huff, 49, who is doing volunteer work she hopes will lead to a job 
helping families affected by domestic violence.

On Jan. 24, the Washington state House approved a spending package that 
would save Disability Lifeline and make cuts to Basic Health to extend its 
life, but only until May. Basic Health currently covers nearly 60,000 
residents who earn less than $21,660 a year. The Senate on Feb. 4 approved a 
plan that would eliminate cash grants under Disability Lifeline, but save 
Basic Health through June 30. The chambers must now work out a compromise.

Some program advocates say the state has options beyond cutting.

"Those aren't the choices," says Ingrid McDonald, state advocacy director 
for AARP. Some health and social service programs could be saved, she says, 
if lawmakers close a variety of tax loopholes, including exemptions for 
first home mortgages, cosmetic surgery, movie tickets, massages and 
non-organic fertilizer.

But in November Washington voters approved measures tying legislators' 
hands: One requires a two-thirds vote of the legislature to pass new fees or 
taxes and another repealed a tax on soda, candy and bottled water that was 
to be used to prop up some health and education programs. They also turned 
down a tax on very high-income residents.

"That isn't much different than what we did last year," says Gregoire. "We 
put together a $700 million revenue package, including two cents on a can of 
pop, and the voters said no."

Nationwide, states enacted $6.2 billion in new taxes and fees during the 
past legislative session, according to the National Association of State 
Budget Officers.  That was down sharply from fiscal 2010, when the states 
imposed $23.9 billion in new taxes and fees. The taxes ranged widely, but 
many increased sales tax or tobacco fees.

While many states went that route in the past two years, today there's "not 
as much appetite for tax increases, so generally the focus is going to be 
more on cuts," says Stacey Mazer, senior staff associate for the budget 
association.

Washington's grim choices are particularly painful given that the state 
spearheaded innovations adopted elsewhere, such as services to keep the 
elderly and disabled in their own homes, says JoAnn Lamphere, national 
director of state government affairs for AARP.

Now, she says, the move to cut such programs "is like a fire catching across 
the states," with 28 expecting to make cuts to them in this fiscal year.

Federal Stimulus Funding Ends

In Washington, home-based care services for low-income people will be 
reduced, affecting up to 45,000 people. And, unless lawmakers come up with a 
way to pay for it, Basic Health will end this spring, affecting nearly 
60,000 residents who earn less than $21,660 a year.

State Rep. Ross Hunter, a Democrat and chairman of the House Ways and Means 
Committee, says he wants to find state funding to keep the program going 
after May - hoping it can last until 2014.  That's when many aspects of the 
federal health care law enacted last year kick in, including new 
marketplaces to buy insurance and subsidies to help people below 400 percent 
of the federal poverty limit - about $73,000 for a family of three -- buy 
insurance.

In the meantime, those on the front lines of health programs say they are 
scrambling in anticipation of cuts.

"It's a crisis," says Rebecca Kavoussi of the Community Health Network of 
Washington. A recent survey of community clinics there found that 40 percent 
expect they will have to close at least one location if proposed budget cuts 
go through, as well as make staff cutbacks and other changes. "Our clinics 
are already getting calls from patients wondering if they can still come 
 in."

Kirk Harmon
President & CEO
Florida Disabled Citizens
for Progress
P.O.Box 61794
Jacksonville, FL 32236
PH(904) 783-9896
Cell: (407) 473-2176
DAV/BVA
Life Member

" TURNING HOPE INTO REALITY"