Impact of Medicaid cuts debated

By Bobby Harrison
Daily Journal Jackson Bureau
JACKSON – Gov. Haley Barbour says that when it comes to Medicaid, Mississippi is doing something no other state does – providing coverage for people who earn up to 135 percent of the federal poverty level.
That distinction has been part of governor’s reasoning in his support of removing about 65,000 elderly and disabled from the Medicaid rolls come July 1.
“Forty-nine other states don’t do this,’’ Barbour has said frequently, referring to the state’s policy of providing health care for elderly and disabled who earn up to 135 percent of the federal poverty level or about $1,050 per individual. “The concerns here are stirred up by some people who don’t recognize other states don’t do this.’’
Leighton Ku, a senior fellow at the nonpartisan, Washington-based Center for Budget and Policy Priorities, said Barbour is not exactly right.
“The governor is exaggerating as politicians often do,’’ Ku said.
Ku, who has called the Medicaid cuts being made in Mississippi some of the deepest he has ever seen, said most states have programs that provide health care coverage to the aged and disabled. About 20 states have programs similar to Mississippi’s, while many others allow people to deduct major medical costs from their income – thus lowering than income level and making them eligible for health care benefits.
Ku said that Mississippi probably does provide health care coverage for a larger segment of its population than any other state. But he added that will change on July 1 when Mississippi goes from one of the most generous states – in terms of the number of people covered – to a state that provides the least amount of coverage required under federal law.
When the new law takes effect, up to 65,000 people could be removed from Medicaid, a state-federal program that provides health care coverage for the elderly, the disabled and poor children. Barbour developed the plan for the cutbacks to slow the rising costs of the rapidly growing program.
The governor has said that about 60,000 of those being removed can receive health care coverage through Medicare, which is solely a federal program and does not require matching funds from the state as Medicaid does. The people are eligible for Medicare benefits, Barbour said, because of massive changes made to the federal law last year.
“I can promise you this,’’ Barbour said at a recent news conference. “If I thought the people’s health care would be jeopardized, I would not have done this.’’
Others said the action in Mississippi will put people’s health and lives in jeopardy. House Public Health and Human Services Committee Chairman Steve Holland, D-Plantersville, said the benefits offered through the new federal Medicare law will not take full effect until 2006 and the benefits offered through the program now are far inferior to what the state provides through Medicaid.
While Holland said the benefits across the board are not as good, it is prescription drug coverage that points to the real difference between Medicaid and Medicare.

What it means
A study done by the Jackson nonprofit Mississippi Health Advocacy Program points out some of the key differences. For instance, according to the study, an elderly woman who uses three prescription drugs costing $50 each per month would spend about $72 per year for her medication under the current Medicaid program.
Through Medicare, after July 1, the woman would spend about $900 per year. If the woman had more expensive prescriptions that cost $200 each, she would have to pay out of pocket expenses of more than $5,000, the study says.
The study said it is not unusual for the elderly to depend on several costly prescriptions.
“Faced with such high out-of-pocket prescription drugs costs, many low-income elderly and disabled people will be unable to afford their prescriptions and could become much sicker without their medications,’’ the study concluded. “Or they would have to make deep cuts in other basic costs of living to scrimp enough together for their medications, cutting their food, rent or utility budgets.’’
The study said that one result could be more uncompensated hospital visits by people who are no longer taking their medication. Plus, Holland said, the governor’s proposal could lead to more elderly being placed in nursing homes where the cost to Medicaid is even greater.
Medicaid pays nursing home costs, which are greater than drug costs, for the elderly who earn up to 300 percent of the federal poverty level.

How it happened
In recent weeks, Holland has asked Barbour to call a special session to reconsider the Medicaid issue. Holland has been criticized for originally passing the Medicaid bill at the end of the regular session in May. At the time, Holland said he opposed the legislation, but said that it was the best he could negotiate with the Senate and the governor.
He said he feared that the governor might have the authority to run Medicaid without legislation and that he might make even deeper cuts.
Instead of facing the possibility of the governor running the program with no legislation, Holland and other House members negotiated a deal in which Barbour would try to obtain a federal waiver for the 5,000 who would be removed from Medicaid, but did not qualify for Medicare.
The waiver is needed because under federal law, all similar groups in the same income category must be covered equally by Medicaid. Plus, at the House’s insistence and with concurrence from the Senate leadership, the governor agreed to try to get the same waiver for heart transplant patients, kidney dialysis patients and certain cancer patients.
Those three categories total about 15,000 people.
The state is still awaiting word on the waivers, though, both Barbour and Holland think the federal government will grant them. If the waivers are granted, about 45,000 of the 65,000 will have only the Medicare benefits. But some of those people have been calling legislators and the governor’s office, saying they are as sick as those who might receive waivers.
Responding to those phone calls, the House during the recently completed special session voted overwhelmingly twice – both Democrats and Republicans – to restore eligibility to the whole group. The Senate leadership prevented a vote on the issue, saying that the governor decides what can be covered in the special session and he had not included Medicaid in the topics to be considered.
Holland said most of the Senate also would vote to restore Medicaid eligibility if given the chance.
“Something needs to be done,’’ said Sen. J.P Wilemon, D-Belmont. “… I would vote to restore it.’’
Rep, Greg Snowden, R-Meridian, said he would be for restoring the eligibility, but questions whether the state can afford it. It would cost about $42 million. Holland claims that Medicaid is receiving more money than it has ever received and argues that the people could be taken care of within the existing budget.
The state receives about $3 in federal funds for every $1 it spends on Medicaid. Mississippi receives the most generous match in the nation from the federal government for its Medicaid program.
Senate Public Health and Welfare Committee Chairman Alan Nunnelee, R-Tupelo, who helped Barbour pass the legislation, said that word finally has filtered down to the regional Medicaid offices of the changes in the program. He said that he believes the regional Medicaid staffers will now be able to provide the people who will be removed from Medicaid with the information they need to qualify for Medicare benefits.
But he added, “What we need to do is continue to monitor the situation. If people are getting their pharmaceuticals, there is no need to change the legislation. On the other hand, if people are not getting their pharmaceuticals, we need to revisit this.’’

Bobby Harrison can be reached at (601) 353-3119 or