Thirteen states are moving to cut Medicaid by reducing benefits, paying health providers less or tightening eligibility, even as the U.S. government is set to expand the insurance program for the poor to as many as 17 million more people.
States routinely trim the program as tough times drive up enrollment and costs. The latest reductions -- which follow more extensive cuts last year -- threaten to limit access to care for some of its 60 million recipients.
"With more people on Medicaid, states will have to continue to ratchet down payments and limit services," says Nina Owcharenko, director of the Center for Health Policy Studies at the conservative Heritage Foundation.
Some worry cuts to doctors and hospitals could make it harder to expand the state-federal program in 2014, as called for by the federal health law. "Some providers may be unwilling to accept new Medicaid patients," former New York Medicaid director Deborah Bachrach says. She notes the law may counter that effect with its funding boosts to community health centers and its temporary rate increases for primary-care doctors, beginning in January.
Most of the cuts went into effect this month, according to a 50-state survey by Kaiser Health News for USA TODAY. Among them:
Illinois limited enrollees to four prescriptions a month, imposed a co-pay for prescriptions for non-pregnant adults and raised eligibility to eliminate more than 25,000 adults.
Alabama cut pay for doctors and dentists 10% and eliminated coverage for eyeglasses.
Florida cut funds to hospitals treating Medicaid patients by 5.6% and seeks limit of two primary-care visits a month for non-pregnant adults.
California added a $15 fee for those who go to the ER for routine care and cut reimbursements to private hospitals by $150million.
Stacey Mazer, with the National Association of State Budget Officers, notes that fewer states are cutting the program this year, partly because many are in better economic shape and partly because "states are hearing a lot of hue and cry about the impact on access," she says.
Last November, about 3,500 Medicaid recipients in New Hampshire had to find new doctors after cuts led LRGHealthcare in Laconia to stop offering primary care to non-pregnant adults, Senior Vice President Henry Lipman says. It is unclear how many states will join the Medicaid expansion after the Supreme Court ruled that they may not be penalized for opting out.
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a non-profit, non-partisan health policy research and communication organization not affiliated with Kaiser Permanente.
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