2006- State Medicaid and Health Cuts & Expansions

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Medicaid Watch: State Medicaid and Health Cuts & Expansions

By Thomas P. McCormack [draft # 11, April 1, 2006; please discard any earlier version]

Alabama--- Has no spend down; allows only 12 doctor visits & hospital days yearly and 4 brand name Rx’s monthly (but unlimited generics); but new SCHIP applications are again allowed. The 2007 Medicaid budget will be short $200 million. There’s an ADAP waiting list, and extra emergency federal funding has expired. For more 2003-05 details see http://www.kff.org/medicaid/7314.cfm .The state plans to raise doctor payments.

Alaska---this Title XVI state, with no spend down, froze its nursing home income level; cut the CHIP level from 200% to 175% (1,200 families lost children’s care); tightened qualifications for home care & created a SPAP for the aged but not the disabled. There’s an ADAP waiting list, and extra federal funding has expired.                                                    .

Arizona---a referendum & waiver gives AHCCES (waiver Medicaid) to all uninsured parents & children under 200% & to all childless adults under 100%. Even though CMS did agree to let the state impose higher co-pays (e.g., $10 per brand name Rx, $5 per generic, $5 per doctor visit), a court order has so far blocked them.

Arkansas--- Gov. Huckabee (R ) raised $100 million in tobacco & income taxes to save the spend down, Katie Beckett waivers, adult vision care & nursing home payments. Yet rates are too low to attract enough doctors & dentists; there’s an ADAP waiting list (extra emergency federal funding has ended); and a state committee began studying ways to cut the Medicaid budget. But the state got a HIFA waiver to offer barebones, Medicaid-funded health insurance to 50,000 workers & spouses with incomes under 200% ($15/mo premium; 7 doctor visits & hospital days a year; 2 Rx’s a month; $100 deductible; 15% coinsurance), also offering the plan for a $100 premium to 30,000 more with higher incomes.

California---red tape & a lower income level is taking 200,000 parents off the rolls. The Democratic legislature killed most of Gov. Schwarzenegger’s ( R ) proposed cuts. Still, he called for premiums ($4 to $27) for those with incomes over 100% or the SSI level, is forcing the aged & disabled into HMOs, proposed a yearly patient dental care cap of $1,000 & got legislative consent to a deal with CMS on DSH funding for $3.3 billion more in federal funds for 5 years (but some say this is too little & doesn’t offer enough state funds). The Governor made 5% doctor rate cuts & stopped paying extra Medicare HMO premiums for dual eligibles. For more 2003-05 details, see http://www.kff.org/medicaid/7314.cfm

Colorado---has no spend down; a court voided a law to deny benefits to legal aliens & once-blocked CHIP applications are again accepted. Denver’s Medical Center & the University of Colorado Hospital cut their indigent care programs & raised their co-pays. Still, an added $2 million in state funds eased the ADAP waiting list. Cigarette taxes voted by referendum will raise the CHIP level from 185% to 200% (enough to cover 4,000 more children), open 600 more HCB and/or Katie Beckett waiver slots to disabled children (but the state is still closing some current HCB cases), raise funding for low income clinics, raise the parents’ income level to 60% (enough to cover 90,000 more) & fund breast & cervical cancer Medicaid coverage. HIFA waiver plans were dropped, but the state will save $59 million by shifting Medicaid children into HMOs.; and the legislature, opposed by drug makers & some consumer groups, plans to adopt a drug formulary to save even more. The 100% state-funded Colorado Indigent Care program--which covers those not eligible for Medicaid, including those awaiting SSA disability decisions--raised its co-pays: $10 per Rx, $35 per doctor visit, $270 per hospital stay & $15 to $45 per ER visit. For more 2003-05 details see http://www.kff.org/medicaid/7314.cfm

Connecticut—a 209(b) state; Governor Rell (R ) vetoed a bill to stop her from seeking a HIFA waiver; raised family Medicaid & CHIP premiums up to between $10 & $75 monthly (an earlier attempt failed); added co-pays of $1 to $3 for doctors; raised Medicaid’s $1 Rx co-pay to $1.50 & $3; upped SPAP premiums from $25 to $30 & its co-pays from $12/$15 to $16.25; imposed a $100,000 SPAP asset test; required recoveries of SPAP costs from estates of the deceased; dropped legal aliens from welfare, Medicaid, CHIP & SAGA (state-funded welfare & medical programs); cut SAGA grants from $350 a month to $200; forced its patients into HMOs; capped its medical budget; established a commission to study Medicaid “reforms”; and ended Medicaid coverage of chiropractic; naturopathy, occupational, physical/ speech therapy & psychology services for adults. But the Democratic legislature raised the parents’ level back up to 150% & repealed the family & CHIP premium increases; Gov. Rell shelved plans to end waiver coverage for 16,000 CHIP parents; but investigative reporting found Medicaid & CHIP specialist & dentist rates to be too low to attract enough providers.

Delaware---has no spend down, ended its waiver to give Medicaid to childless, non-disabled adults under 100% and caps SPAP benefits (the aged but not the disabled will get unlimited drugs from a private charity until May, 2006). The state created a Cancer Treatment Program for uninsured residents not on Medicare with incomes under 650% FPL & a “CHAP/VIP” state indigent health plan for uninsured adults not on Medicare or Medicaid with incomes under 200%.

District of Columbia---DC’s non-federally-funded Health Alliance covers all uninsured persons under 200% except Medicare & Medicaid eligibles. DC’s Medicaid levels are 100% for the aged & disabled and 200% for families & children. A “DC Homes” plan, with $145 million in DC, federal & private funding, will open 2 & expand 7 low income clinics. DC got CMS approval to raise its QMB & SLMB income levels from 100%/120% FPL to 3 times the SSI level ($1809 monthly), not only making many more Medicare patients eligible for payment of their Part B premiums (plus any due Part A premiums & all Medicare deductibles & coinsurance for QMBs), but thereby also for Part D full subsidy Extra Help, with co-pays of only $2 per generic/$5 per brand name drug & no deductibles, premiums or donut hole. (QMB & SLMB eligibles are deemed eligible for full subsidy Extra Help by the Part D law.)

Florida---Gov. Bush (R ) began to out-source Medicaid, welfare & food stamp eligibility to private firms; and his waiver to privatize Medicaid & convert it, with premium support & health savings accounts, into a “defined contribution ”HMO-type insurance was approved by CMS & the GOP legislature (see Understanding Florida’s Medicaid Waiver Application at www.wphf.org; its progress will be monitored & evaluated by the Georgetown University Health Policy Institute); a waiver pilot starts in two counties in mid-2007 (with plan choices so complex that the state is paying $1.25 million to Florida State University to train enrollee counselors). And 43,000 patients over 60 in northern & central counties are being enrolled even sooner in a 2nd managed care waiver that favors home-based care instead of nursing homes. The state cut the aged/disabled income level from $719 to $603 on 1/1/06 (77,000 lost coverage), just as a computer error cut off thousands of cancer & transplant patients; it set up a Medicaid “reform” commission & abolished its SPAP 1/1/06; and a “fail first” drug rule allows costly mental health drugs only if cheaper ones don’t work (with Lamictal, Paxil, Wellbutrin, Lexapro, Zoloft & Zyprexa exempted). The state again covers adult dentures, takes CHIP applications anytime instead of only 2 months a year and will enroll SSI recipients for food stamps without requiring welfare office visits. Children’s, health , doctor & dentist groups want legislation—and even filed suit---to raise fees for children’s care and forced the state to drop Medicaid prior approval red tape for nutritional supplements for the severely disabled. The legislature & Gov. Bush now plan CHIP cuts of $169 to $219 million due to low enrolment.

Georgia---the state ended spend downs to get nursing home care; lowered the CHIP income level from 235% to 200%; (45,000 children lost coverage) and ended CHIP coverage of vision care, oral surgery & other dental procedures. It cut the Medicaid & WIC level for pregnant women (7,500 lost coverage) & infants from 235% to 185%; raised CHIP premiums from $10 monthly to $35; ended adult coverage for emergency dental care & artificial limbs; is forcing one million patients (including 100,000 aged & disabled and 200,000 CHIP patients (for an estimated $42 million is savings) into HMOs (delayed until 6/06); will start more aggressive disease management for the chronically ill; dropped adult dental care, orthotics, prosthetics & hospice care; planned time limits on eligibility for patients in the breast/cervical cancer category; set up a Medicaid “reform” commission; capped HCB waiver program expenses; and tightened medical eligibility for & added cost-sharing fees to Katie Beckett waiver care (which a 2006 supplemental budget shifts into a public-private foundation that proponents claim will bolster its funding). Gov. Pedue (R ) originally sought a CMS HIFA waiver to cut nursing home access, raise Rx & other co-pays (even for children & nursing home patients) & add more managed care & health savings account features to Medicaid and required applicants (except pregnant women & newborns) to document income & citizenship/legal residence. But then in January, 2006, state officials postponed most “reforms” until at least 2007 and said even then they’d be far less extensive and a state health board voted to ease the 90 day coverage suspensions for children with parents delinquent in paying CHIP premiums. The state’s ADAP may have to adopt some cost-containment measures. In 2005, CMS forbade further use of accounting gimmicks bringing in $300 million yearly in added federal funds; state, CMS & hospital officials began re-negotiating allocation of DSH funds ($419 million in 2004); and rising tax revenues will let the state cut far less than the $269 to $388 million first projected.

Hawaii—a 209(b) state; a “Quest” waiver gives Medicaid to families & all the uninsured under 200%, except for the aged & disabled, who must be under 100% to get it. The state requires employers offer health coverage to employees & dependents and just created a SPAP to supplement Part D for aged and disabled patients, but with an income level of only 100%. Gov. Lingle (R) raised the family income level from 200% to 250% (covering 29,000 more persons), lowered CHIP premiums, restored adult dental coverage and expanded substance abuse treatment.

Idaho---this Title XVI state, with no spend down, raised the CHIP level from 150% to 185% (but with less benefits & more co-pays than for poorer patients) & funded a pilot health plan for 1,000 adults with new taxes. The Governor signed a bill to cover the working disabled. But it cut funds for non-federal medical aid for the temporarily disabled & those awaiting SSA disability decisions; ended mandates for private health insurance coverage of mammographies, prostate cancer screening & mental health; and is seeking a waiver to divide the Medicaid/CHIP caseload into 3 classes: Healthy parents & children; the disabled & chronically ill; and the aged—and then charge higher premiums & co-pays to the first class (but probably the others too) and tailor different (and maybe more limited) benefit packages for each group, while beefing up preventive care & incentives. There’s an ADAP waiting list, and extra emergency federal funds have expired.

Illinois---this 209(b) state’s main SPAP (funded as a Medicaid Pharmacy Plus waiver) excludes the disabled, who have gotten only a limited formulary from a separate Circuit Breaker SPAP, but a bill backed by the Governor & legislative leadership will add HIV drugs to it. The state raised the family income level to 185% (covering 56,000 more adults & children), cut eligibility red tape & passed a hospital tax to fund Medicaid. Then it raised income levels even higher to cover 253,000 more children, agreed to a court order raising doctors’, specialists & EPSDT rates for children’s care by $45 million a year & cut HMO rates by $70 million. A Lewin study projected 5 year savings of $1.5 billion if the state forces patients into HMOs, which it will now do to fund the children’s expansion (HMO enrollment had been voluntary).

Indiana---this 209(b) state’s SPAP still excludes the disabled; and, despite court suits, it still has a much-stricter-than-SSI “209(b)” Medicaid disability rule (one must be fatally or incurably ill). Gov. Daniels (formerly the GOP federal budget-cutting czar) once called for more taxes on the rich to prevent Medicaid cuts, but was then silenced by anti-tax zealots. The state will double CHIP premiums & cut the HCB waiver budget by $14 million in 2006 but will let Medicare patients into its risk pool for secondary coverage at discounted rates & add 500 more HCB waiver slots (but a KPMG audit found many waiver problems). The state had to take ADAP cost-containment actions & is soliciting bids for a $1 billion contract to privatize food stamp, welfare & Medicaid eligibility, which will close up to 107 welfare offices with 2,500 workers.

Iowa---the state has a waiver to offer Medicaid (with premiums up to 5% of income) to up to 30,000 more persons--whether they’re aged, disabled, a parent or not--with incomes under 200% but only at two public hospitals. Yet there’s actually no uniform statewide waiver outpatient drug benefit: Waiver patients who are also previous U. of Iowa hospital “state papers” indigent program patients are nominally grandfathered-in, only for a year & with high co-pays, for its free drug formulary; while Polk County residents on the waiver can also access that county’s public hospital free drug formulary; but outpatient drug coverage for other waiver eligibles is sketchy or non-existent. The ADAP waiting list was only partially & temporarily served by now-expired extra emergency federal funding---although $275,000 in state funds were added to the ADAP budget. A state legislative committee began studying ways to cut Medicaid, but Gov. Vilsack proposed a 80-cent hike in the cigarette tax to subsidize health insurance for workers with employers of 25 or less.

Kansas---this Title XVI state’s SPAP ended 1/1/06. Spurning Gov. Sibelius’ (D) call for more health coverage, the GOP legislature passed only token health “reforms”, a limited tax credit to expand small employer coverage, health savings account measures & a health care re-organization. But a new hospital tax will fund higher hospital & physician rates; Blue Cross, with foundation support, will subsidize health insurance for Kansas City-area families making under $30,000; and the state started a generic drugs-only discount plan offering savings of 15% to 80%, for a $10 annual premium, to anyone under 200% FPL who doesn’t have any public coverage.. The state will have to adopt ADAP cost containment measures by March, 2006. A legislative committee studying ways to cut Medicaid has so far called only for more anti-fraud efforts, even though the state must now repay $120 million taken from road funds to avoid health & other cuts in 2001-03. Because the state Medicaid plan (possibly by error) limits coverage of disabled children in large facilities to 140/180 days--even though unlimited medically necessary stays would be allowed by federal rules—CMS is now denying federal matching for over 500 of them, causing the state to send them to regular foster care, small group homes or state hospitals..

Kentucky--- the state raised Rx co-pays to $1 per generic, $2 per preferred brand name & $3 per non-preferred brand name drug. But it dropped earlier-tightened nursing home & HCB care medical qualification rules; raised the cigarette tax by 30 cents-a-pack (to fund education & Medicaid) with a further 10-cent raise under study; even reinstated 2,500 formerly-dropped mentally ill clients; and passed a law to create a SPAP for the aged only---but not the disabled---but then failed to implement it. There’s an ADAP waiting list, now that extra emergency federal funding has expired—and a $215 million state funds Medicaid shortfall for fiscal 2006. That, and CMS’ decision to disallow county hospital, clinic & nursing home budgets as state matching funds, will cost the state $100 million & led it to get a waiver with limits of 4-prescriptions-a-month, 15 occupational/physical therapy visits-a-year & 12 x-rays/MRIs-a-year (with appeals allowed), $2 to $10 co-pays for doctor visits, $2 to $20 co-pays for other outpatient care, $10 to $20 co-pays for non-emergency ER visits, a whopping $20 to $50 co-pay per hospital stay ; annual cost-sharing caps of $225 a person & $350 a family, except for non-Louisville-area patients, who’ll be put into an HMO with a $450 cost-sharing cap (children would face only Rx co-pays; and preventive care would be co-pay exempt); and with co-pays of $3 per generic, $10 for “preferred” & $22 for “non-preferred” brand name Rx’s on spend downers. The Medicaid caseload would be divided into 4 groups: “healthy” adults; children; aged & disabled adults (including those needing nursing home, home health & HCB waiver care); and the mentally retarded. Each would get different benefits and different, but higher, cost-sharing—but smoking cessation, weight loss & even gym fees would be covered. The state settled a federal class action suit by moving 1,500 disabled patients---and 1,000 others soon-- into HCB care and Gov. Fletcher (R ) proposed state subsidies of $40-$50 monthly per employee for health insurance coverage in small businesses, but a bill to do so died in the state senate.

Louisiana---the state cut allowed Rx’s from 8 to 5 monthly, closed 210 local health centers, cut Charity Hospital & school health services & adopted a formulary. A new hospital tax will bring in $200 million more in state & federal funds but the state had to adopt ADAP cost-containment measures. CMS dropped its claim for a refund of $340 million from past matching funds because of a fishy funding scheme. Hurricanes Katrina & Rita cut state revenues ($1 billion+ for 2005-06 in a legislative study; $1 to $3 billion+ in a federal CBO estimate); and left the Charity Hospital System with no 2006 funding. Even though the Budget Reconciliation bill offers $2.1 billion for paying all of LA’s & MS’ Medicaid & uncompensated care costs at a 100% match , the state already had to slash its very low physician rates by 10%.

Maine---the state subsidizes health insurance for small employers’ workers & their families; raised the Medicaid level for the childless--aged, disabled or not--to 125% (but then barred new childless, non-disabled adults) & for parents to 200%; planned coverage of the working disabled; and adopted a formulary (with physician over-rides allowed). When the health budget faced shortages, the state raised income taxes on the rich & on tobacco, alcohol, hotels, restaurants, car rentals & soft drinks to fund health care but also appointed a commission to study ways to cut Medicaid expenses.

Maryland---almost all Governor Ehrlich’s (R ) planned health cuts failed in the Democratic legislature, but he did get a ban on new CHIP patients with incomes over 200% and, at least temporarily, CHIP premium raises. He also set up a Medicaid “reform” commission and dropped coverage for legal immigrant children & pregnant women here less than 5 years (which the legislature will try to reverse in 2006). A state court ruled that excluding legal immigrant children violates the state constitution, while the AARP & Legal Aid filed suit saying the state’s HCB waiver medical admission criteria are illegally strict. The state’s lower income band SPAP now excludes Medicare patients, while its higher income band SPAP still excludes the disabled & even cut its benefits. Advocates say that Medicaid & CHIP specialist & dentist rates are too low to attract enough providers. The state did start a high risk health insurance pool, but in 11/05 a state insurance board let small employer health plans covering 450,000 persons drop all meaningful drug coverage. The legislature overrode Gov. Ehrlich’s veto of a tax (dedicated to Medicaid and CHIP costs) on employers of 10,000 or more which don’t pay at least 8% of revenues toward employee health insurance (WalMart is the only such employer).

Massachusetts---after almost all of Gov. Romney’s (R ) health cuts (except ending almost all MassHealth adult dental care; see http://www.kff.org/medicaid/7378.cfm for details) failed in or were reversed by the Democratic legislature, he supported cheap, limited benefit, high cost-sharing policies for the uninsured; more enrollment in Medicaid, a higher minimum wage for firms that don’t offer health plans & a “ CAP” program to give food stamps automatically to SSI recipients; and drafted a plan to give health insurance to 500,000 more persons. But he established a Medicaid “reform” commission; called for tougher work rules even for disabled welfare clients awaiting SSA disability decisions; limited state-funded “Free Care” patients to low income clinics; and imposed $3 clinic & generic drug and $5 ER & brand name drug co-pays on them. In October, 2005, an informal waiver giving the state $585 million extra in federal funds to match state funds from questionable financing schemes expired & CMS threatened to cut $385 million in Medicaid funds if the state doesn’t somehow insure half a million more residents. The House passed a bill imposing 5% to 7% payroll taxes on employers of 10 or more who don’t offer health insurance to raise $176 million yearly to boost the CHIP income level from 200% to 300% & the parental level from 133% to 200%; cover childless, non-disabled adults under 100%; and subsidize health insurance for 200,000 more (but the Senate passed a slightly less liberal bill). A final compromise bill was then crafted by both Houses’ leaderships, which Gov. Romney may or may not sign. He did restore dental care for women who are pregnant or have children under 3. For more 2003-05 details, see http://www.kff.org/medicaid/7314.cfm .

Michigan--- the state, even with raised tobacco & hospital taxes, still had to end almost all Medicaid adult dental, hearing aid, podiatry & chiropractic care and stopped enrolling new childless non-disabled adults under 100% FPL into its Medicaid expansion waiver (which doesn’t cover inpatient care). The House named a committee to find more Medicaid cuts & the House & Senate (both GOP-led) passed bills creating or raising Medicaid & SCHIP premiums & co-pays, which Gov. Granholm (D) called “unprecedented in [their] cruelty”. But she signed a bi-partisan compromise to grandfather-in current recipients; adopt some GOP cost-sharing; impose some stricter eligibility rules on new applicants only; and even require patient urine tests for smoking & sugary/fatty diets (violators face $10 penalty premiums)--while restoring adult dental care (after a recent survey found that only 15% of dentists accept Medicaid due to low rates & red tape, the state raised children’s dental rates to private-pay levels) and vetoing a 4 year welfare limit bill. The SPAP was abolished but Granholm proposed health insurance reform to cover the working poor & small firm workers. In 3/06 a federal judge voided a state law letting providers force patients to actually pay their Rx co-pays—but in March, 2006, the Senate voted to further raise patient cost-sharing..For more 2003-05 details, see http://www.kff.org/medicaid/7314.cfm

Minnesota---this 209(b) state raised premiums & co-pays for Medicaid, CHIP & MinnesotaCare (state-subsidized health insurance), cut the latter’s income levels and denied Medicaid & CHIP to legal aliens. But GOP plans to abolish the state-only medical program for the childless who are jobless or disabled & awaiting SSA disability decisions) and cut 30,000 from MinnesotaCare failed--and some previous MinnesotaCare cuts were restored--after Gov. Pawlenty (R ) & the Democratic Senate compromised by enacting a 75-cents-a-pack cigarette “impact fee”. A court order voided a state law letting Medicaid providers deny care or Rx’s to those who don’t make co-pays, yet the state’s ADAP began to drop patients who don’t or can’t make co-pays & it discontinued its SPAP on 1/1/06. But Gov. Pawlenty proposed a $2.5 million drug discount program for the uninsured & Part D donut hole patients and $4.5 million more for the state SHIP.

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Mississippi---has no spend down; cut its income level for the aged & disabled from $817 to $603 on 1/1/06 & 65,000 patients lost Medicaid. A state committee began studying Medicaid “reform”. Brand name drugs were cut to only 2 monthly (plus 3 generics), but with an informal, perhaps temporary, exception allowing 5 brand name drugs for HIV patients (a suit challenging these limits is pending). A state study estimated state revenue losses from Hurricane Katrina at $213 to $272 million+ just for 2005’s last quarter, but the Budget Reconciliation bill includes $2.1 billion for paying all of MS’ & LA’s Medicaid & uncompensated care costs at a 100% match for as long as that money lasts.

Missouri---this 209(b) state cut the aged/disabled income level from 100% to 85%; ended state medical aid & welfare for the temporarily disabled & those awaiting SSA disability decisions; ended Medicaid for the working disabled; cut the parents’ income level to 23% from 75% (but a court reinstated parents who can qualify in the welfare-to-work, disabled or aged categories); ended adult dentistry, hearing aid, crutches, wheelchair maintenance, walkers & eyeglasses benefits; enacted new & bigger Medicaid co-pays; raised CHIP premiums, made 46,000 more children pay them & denied CHIP to those seemingly able to get “affordable” employer coverage, even if it’s really too costly or inadequate (causing 20,000 to lose coverage); and tightened medical qualifications for nursing home, HCB & home health care. But CHIP co-pays were ended, doctor & nursing homes rates were raised by $36 million & the SPAP was expanded to cover the disabled (but not those in the 2 year waiting period). Blue Cross, with foundation aid, subsidizes health insurance for Kansas City-area families earning under $30,000. The state’s ADAP had to adopt some cost-containment measures. The state Medicaid “reform” committee called for different benefit packages for families & children, the disabled and the aged; more cost-sharing for all patients; some mandatory preventive care; but also for restoring coverage of the working disabled (but a very low extra unearned income test restricts eligibility).The legislature restored coverage of the working disabled, eyeglasses & wheelchair supplies. Advocates are petitioning for a referendum (see www.peoplesagendafund.org ) to raise tobacco taxes to restore the other cuts—but, even with a $245 million surplus, Gov.Blunt opposes it. A new documentary. Out of Sight, Out of Mind addresses the cuts; contact paul@RagTagFilm.com (573) 443-4359 about availability.

Montana---the state added more & bigger co-pays to Medicaid & CHIP, slashed TANF (welfare) grants, restricted nursing home eligibility, cut doctor visits for the aged & disabled to 10 yearly, dropped coverage of some hospice & home health care & added red tape to cut enrollment--but did find money to end the CHIP waiting list. The state’s “Passport to Health” & Team Care programs save over $20 million yearly by assigning primary care doctors to patients to reduce ER, hospitalization & other costs. The state is seeking a HIFA waiver to fund a higher CHIP income level to cover 10,000 more children & give watered-down Medicaid to 3,000 more adults and created a SPAP to pay up to $33.11 in Part D premiums for those aged and disabled Medicare patients under 200% (but won’t pay any deductibles, co-pays or coinsurance or for drugs uncovered by Part D plans, nor cover the disabled still in the 2 year waiting period). There’s an ADAP waiting list, now that extra funding has ended. A state-Blue Cross pact on funding a $12 million rise in CHIP costs without higher premiums, a referendum-voted tobacco tax & more state money will fund 2,000 more children on CHIP.

Nebraska----this Title XVI state ended coverage for 15,000 welfare-to-work parents & childless, non-disabled 19 & 20-year-olds. There’s an ADAP waiting list, now that extra emergency federal funding has expired. A state committee suggested Medicaid savings (making it a “defined contribution” plan & promoting assisted living & HCB waivers over nursing home care) of $72 million a year (see http://www.hhs.state.ne.us/med/reform/ ). But, while stopping short of creating a full—fledged SPAP, the state will pay Part D co-pays for those dual eligible Medicare-Medicaid patients in SNFs, ICFs & HCB waiver programs and assisted living, personal care, adult family, board & care & group homes.

Nevada---this Title XVI state, with no spend down, ended its disregard of unemployment benefits & dropped plans to end the asset test for pregnant women & child-only coverage. Yet it raised $1 billion in new taxes to fund Medicaid; added Ticket to Work coverage for the working disabled; raised the SPAP’s income level, adapted it to supplement Part D for limited income patients & added SPAP coverage of the disabled (including those in the 2 year wait); planned to use unspent CHIP money (with a waiver) & a CMS risk pool grant to fund health insurance for small employers’ workers & their dependents; added limited adult dental & vision care; added $746,000 to ADAP funding; raised CHIP premiums; rejected adding Medicaid co-pays for Rx’s & other care; and set up a committee to study further Medicaid budget cuts.

New Hampshire---this 209(b) state’s holdover Medicaid Director, often without the Governor’s consent, works with the GOP legislature (which set up a Medicaid “reform” committee) for a HIFA waiver to tighten nursing home eligibility. But Gov. Lynch (D) called for more CHIP enrollment & he added $180,000 more to ADAP. The state authorized a SPAP to supplement Part D for low income aged and disabled Medicare patients (but it excluded the disabled in the 2 year wait & then funding plans were vetoed by CMS); it enacted a 28 cents-a-pack tobacco tax increase to help fund health costs (but tied it to road toll & Medicaid changes that could undermine funding); and plans to hire a private firm to ‘coordinate” and foster cheaper, better care for the chronically ill & heavy users. It still has a much-stricter-than-SSI “209(b)” Medicaid disability rule (inability to work for at least 4 years).The state’s ADAP had to adopt cost-containment measures.

New Jersey---in 2001-04 the state cut the parents’ income level, dropped legal aliens, stopped paying hospital bills in its state-only program for those awaiting SSA disability decisions & privatized eligibility determinations for CHIP, FamilyHealth & Medicaid. But it then cut eligibility red tape, is gradually raising the parental level back up to 133% (enough to cover 80,000 more parents), seeks a waiver to cover non-disabled, childless adults under 100% FPL and rejected co-pays for Rx’s, doctor visits & adult day care. Still, Gov. Corzine (D) says the $4.5 state budget deficit will require stronger generic drug mandates, bulk state drug purchasing and a $620-per-bed hospital tax .

New Mexico—has no spend down; its Medicaid waiver expansion to uninsured adults under 200% still excludes disabled & aged Medicare eligibles. The state established a Medicaid “reform” commission and plans to—or, as necessary, is seeking waivers to--impose co-pays of $2 per Rx, $5 per office visit, $15 per ER visit & $25 per hospital admission; to require an “enrollment fee” of $25 & a $10 annual premium; to eliminate rural transport costs to get prescriptions; to end adult eyeglasses & other medical equipment coverage; and to end non-emergency coverage for illegal aliens. But Gov. Richardson changed eligibility re-certifications to once, rather than twice, a year; boosted outreach; will raise income levels enough to cover 7,800 more children & 1,200 pregnant women; and proposed tax-subsidized health insurance.

New York---a “Family Health” waiver covers parents under 150% & childless (even non-disabled) adults under 100% but not childless Medicare patients (who must be under the lower SSI/SSP level for Medicaid). State-subsidized “Healthy NY” insurance for workers under 250% (a recently-reported NYC premium was $170 monthly), excludes part timers & Medicare patients & caps yearly Rx’s at $3,000. The legislature failed to add the disabled to EPIC (the state’s aged-only SPAP), even though Part D will save it over $113 million yearly; began forcing SSI recipients into HMOs; imposed a 9 month uninsured waiting period for, and forbade public employees from getting, Family Health; raised its co-pays to $5 for doctors & dentists; and to $3 for generic & $6 for brand name Rx’s; ended non-clinic podiatrist coverage; raised other Medicaid Rx co-pays to $1 per generic & $3 for brands; capped yearly Medicaid co-pays at $200; started a formulary allowing doctor over-rides (but which Gov. Pataki now seeks to revoke to save $36 million); is planning cheaper assisted living & adult day care instead of costlier nursing homes (e.g., $25 million more for 1,000 state Aging agency home chore aides & a waiver request to fund 5,000 more); and seeks to extend a waiver to let HMOs,& clinics enroll patients (they’ve added 1 million to the rolls). The counties’ lobby & the GOP Assembly are studying how to cut Medicaid & a lawsuit seeks to ban counties from making migrants from other counties re-apply, against CMS rules. New York makes the City & its counties must pay half of non-federal Medicaid costs, but Gov. Pataki (R) proposed capping those locally-borne costs at 3.5% yearly, saving localities $1.1 billion a year (but that would then be made up by hospital & nursing home rate cuts, raising Family Health ER co-pays to $25 & tighter nursing home asset transfer rules); and also would spend $160 million of Empire Blue Cross conversion charity funds on medical research rather than care for the poor & uninsured. State leaders neared finalization of a bi-partisan measure to allow hospitals to charge only “nominal” fees to self-pay, uninsured patients under 100% FPL; allow sliding scale charges to those between 100% & 250% FPL; limits charges for those between 250% & 300% to whatever discount rate the hospital’s largest insurer pays; and forbids forced home sales for delinquent hospital debts. For more 2003-05 details see http://www.kff.org/medicaid/7314.cfm

North Carolina---after the state earlier cut Medicaid’s pregnant women & infant income level from 185% to 151% & dropped childless, non-disabled 19 & 20 year-olds, 2005 Senate bills to cut the aged/disabled income level from 100% to 73%, cut 8,000 others off the rolls & slash home attendant care failed. Instead, the state added coverage of the working disabled & $1 million more to ADAP; but it did cut Rx’s to 5 brand names a month (with unlimited generics) & abolished the SPAP 1/1/06. There’s a long ADAP waiting list again; and CMS made the state cut back $80 million in HCB care, case management & aides for 5,000 disabled persons. The state will make up $30 million of that with state & county school funds; and it’s reorganizing publicly-funded behavioral health care, saying changes will net out to more services. More and more counties are bitterly protesting a state mandate that they pay 15% of Medicaid costs with local taxes.

North Dakota---this 209(b) state established a Medicaid “reform” commission.

Ohio---this 209(b) state cut the parental income level from 100% to 90% (27,000 lost Medicaid 1/1/06); raised Rx co-pays to the $3 federal maximums; cut the adult dental care budget by 50% (which reduced access & services); cut some vision, podiatry & psychologist services & Medicaid secondary payments for dual eligibles also on Medicare; ordered all patients not on Medicare into HMOs; slashed $80 million over 2 years from the non-federal Disability Medical Assistance (DMA) program for over 15,000 destitute disabled awaiting SSA disability decisions; authorized providers to refuse service to patients who don’t meet co-pays (which was against federal law). Yet it created over 2,000 new HCB waiver slots and added coverage of the working disabled. Even though Ohio’s $504 monthly aged/disabled Medicaid level is already the nation’s lowest, a state legislative committee is planning further Medicaid cuts; no new DMA applications are being taken; and current DMA patients must complete forms “proving” they need medical care.or lose coverage.

Oklahoma---this 209(b) state cut the Medicaid level from 185% to 100% for children over 1 & from 100% to the SSI/SSP level for the aged & disabled, ended the spend down for families & children, re-imposed a “3-prescriptions-a-month” limit and cut the nursing home & HCB waiver income level. But Gov. Henry (D) did add coverage of the breast & cervical cancer and working disabled eligibility categories. A referendum raised tobacco taxes enough to fund a Medicaid HIFA waiver to subsidize health insurance for over 50,000 small firm workers & their spouses with incomes under 185%. A state legislative Medicaid “reform” committee recommended, and the House voted, to save $100 million by cutting fraud & abuse; giving recipients a “menu” of “customized”, cheaper benefits; paying premium support instead of secondary, wraparound Medicaid if patients can get work coverage; promoting health savings accounts; ending coverage mandates for private insurance; cutting ER costs by promoting primary care; raising provider fees; covering students to age 23; and raising the Medicaid budget by $93 million! The state’s ADAP had to adopt some cost-containments.

Oregon---a Title XVI state with no general spend down; a tax cut referendum caused 70,000+ childless, non-SSI & non-TANF adults to lose coverage through income level cuts & big premium raises & ended spend down eligibility for all but transplant & HIV patients (Oregon Health Plan enrollment fell over 50%). To carry out the legislature’s last cuts, the state limited adult dental care; ended adult vision & all OTC pharmacy coverage; limited urban non-HMO in-hospital days to 18 yearly; and took more ADAP cost containment steps. Still, there’s a $140 million health & welfare deficit for 2007.

Pennsylvania---budget shortages made the state temporarily close enrollments for state-subsidized “AdultBasic” health insurance for adults under 200% (it excludes Medicare patients & has no pharmacy benefit) & the state’s SPAP still fails to cover the disabled under age 65--even though it will save $100 million each 6 months because of Medicare Part D’s start. Consumer groups filed suit objecting to state-CMS plans to enroll dual eligibles in pre-selected, individual Part D plans---and the state is now re-negotiating all this with CMS. The state imposed premiums of $40+ monthly plus more & higher co-pays on Katie Becket waiver children in families making over $40,000; and cut covered inpatient hospital stays to twice a year (but only once yearly for General Assistance patients), inpatient rehabilitation stays to once a year & doctor or clinic visits to 18 a year for adult male patients. But it rejected higher Rx co-pays & monthly numerical Rx limits. Gov. Rendell got $85 million more from state Blue Cross plans for the AdultBasic insurance budget (which will cover 30,000 of the 120,000+ on its waiting list. The state will have to adopt ADAP cost containment measures in 2006; and its Blue Cross plans (which are CHIP contractors) were caught wrongly enrolling poor children in their own $50-premium “Special” plans---which, unlike CHIP, have no dental, vision, hearing or drug coverage—instead of CHIP.

Rhode Island---the state resisted calls to close enrollment or cut the 185% parental income level for RIghtCare (a waivered Medicaid/CHIP expansion) & instead added limited coverage of the disabled over 55 to its former aged-only, limited-formulary SPAP & offered Ticket to Work Medicaid to the working disabled. Gov. Carcieri (R ) blamed Medicaid for “sucking up” the state budget, proposed dropping 3,000 undocumented children, but also for using $10 to $17 million in state tobacco funds & new insurance taxes to subsidize health insurance for the working poor & small firm employees.

South Carolina---has no spend down; a SPAP operated as a Pharmacy Plus Medicaid waiver covers the aged between 100% to 200%--but not the disabled. The state raised co-pays for some families on Medicaid & CHIP; cut Medicaid Rx’s from 4 to 3 monthly; and added $2 co-pays for doctor visits; $3 for dentists; $3 for medical equipment; and $1 for optometrists, chiropractors & podiatrists (Rx co-pays were already $3). It asked for CMS waivers to introduce a form of Medicaid health savings accounts; to raise co-pays (e.g., $5 per Rx, $100 per hospitalization. $25 per outpatient surgery); to reduce care for children & youths—but then dropped the latter proposals after a public outcry (there’s still a court suit to block the whole waiver). The SPAP now covers all but a 5% coinsurance of drug costs for Part D patients with incomes under 200% after they reach the donut hole (it also reduces the otherwise-applicable 15% coinsurance to 5% for those with incomes between 135% & 150% after they reach what would—if they weren’t on Extra Help--otherwise be their donut hole) but it still excludes the disabled. The state plans to re-impose asset tests for family & children coverage (one vehicle & one home of any value plus $20,000 in liquid & other assets). Democrats are seeking new tobacco taxes.

South Dakota---has no spend down; plans a high risk health insurance pool & its ADAP had to adopt cost-containments.

Tennessee----the state ended Tenncare (waivered Medicaid) coverage of 191,000+ aged, disabled & parents with incomes over SSI or TANF levels & “uninsurable” adults, although children are exempt from cuts. Except for pregnant women, children & HIV+ persons, doctor’s visits are limited to 10 yearly, hospital days to 20 & Rx’s to 2 brand names plus 3 generics monthly (with $3 co-pays & exceptions for HIV & Hepatitis C drugs). The state adopted a formulary; will set ER co-pays at $5 (or even $5 for some brand name Rx’s if CMS agrees); and end methadone coverage. It did offer aged/disabled ex-patients temporary Rx discount cards for up to 55 free generics (plus one brand-name anti-psychotic a month for the mentally ill); budgeted $20 million more for low income & county clinics (with co-pays of only $5), $5 million for post-transplant & $3 million for cancer care of dropped patients; gave ex-patients with cancer, hemophilia, kidney failure & transplants “safety net” services through 6/06; continued home nursing care until 6/06; and even covered Weight Watchers. It did have to take ADAP cost containment measures. But with savings from the cuts, it will again cover up to 100,000 medically needy persons (giving them yearly eligibility); raise income levels for pregnant women & infants; add hundreds of HCB waiver slots; cover 150,00 more children with a raised income level; subsidize a barebones health insurance, modeled on the Healthy NY program, for the working poor (but many who lost Tenncare are disabled & aged too sick to work); revive its high risk health insurance pool (but with unaffordable premiums & no discounts for the poor or Medicare patients); and sponsor prescription discounts on generics & some (but not most) brand name drugs for those under 250% FPL; See www.tenncare.org for plan details & critiques. Yet it ended coverage of benzodiazepines & barbiturates (even for anxiety, epilepsy, seizure & mentally ill patients, over-riding its own pharmacy committee). For photos & bios of disabled patients who lost Tenncare, see http://www.joonpowell.info/tenncare.html.

Texas—In 2003-04 the state dropped its family-only spend down; ended CHIP coverage of prostheses, physical therapy & private duty nursing; tightened CHIP asset rules; imposed $10 to $20 co-pays for CHIP doctor visits & Rx’s; raised CHIP premiums; counted income for CHIP more strictly; imposed a 90 day wait to enroll in CHIP; reduced Medicaid home health care; and ended adult chiropractic & podiatry coverage. But a state law denying Medicaid to parents who abuse drugs or alcohol or whose children miss school or checkups was voided by a court. The state set up a Medicaid “reform” commission & wants a waiver to force TANF children & families in 8 large counties into HMOs that will spend $109 million less on their care each 2 years, but complex hospital rate issues delayed similar HMO contracts for the aged & disabled. Texas awarded $899 million to a private firm for food stamp, TANF & Medicaid eligibility work, laying off 2,900 state eligibility workers & closing 100 welfare offices (but advocates say that contractor red tape & poor service made 100,000 children lose Medicaid or SCHIP since 11/05). Texas ADAP had to take cost-containment measures, but did ease access to Fuzeon; and the legislature restored funding for Medicaid & CHIP mental health, vision & hearing aid coverage & CHIP dental care. In 2005, a court found the state to be violating an order for better EPSDT outreach. The state’s transfer of $20 million from Planned Parenthood birth control clinics—to sanction it for covering abortions with separate, private funds--to general low income health clinics instead misfired by simply denying birth control to many working poor women. For more 2003-05 details, see http://www.kff.org/medicaid/7314.cfm. By March, 2006, the state was seeking $2 billion in extra federal funds for health & other costs of thousands of Louisiana Katrina & Rita evacuees.

Utah---this Title XVI state’s HIFA waiver gives watered-down Medicaid (no hospital, specialists’, nursing home or home health care; big drug & other co-pays; see http://www.kff.org/medicaid/kcmu030706pkg.cfm for a waiver critique) to all uninsured adults under 150% --except for Medicare eligibles (who must be under 100% for regular Medicaid). The state ended Medicaid adult coverage of podiatry, audiology, speech, occupational & physical therapy and vision & dental care; and, in 2006, refused to again cover dental & vision care, raise doctor fees (which now don’t attract enough providers) or fund more services needed by the severely disabled. The state’s ADAP had to adopt some cost-containment measures.

Vermont—Gov. Douglas’ (R ) 2004-05 cuts—except for slashing adult dental care, which the House voted to restore in March, 2006---failed in the Democratic legislature & he vetoed a bill to cover the uninsured. But CMS approved his proposed “HIFA” waiver which, in exchange for about $400 million extra to meet projected 5 year deficits, will force patients into HMOs, promote HCB care over nursing homes & tighten up asset transfer bans-- but also cap future federal funds. The waiver got final legislative approval in 12/05. But low fees deter many doctors, dentists & specialists from taking Medicaid patients & thus limit access to care. New tobacco taxes will meet almost half an expected health deficit.

Virginia---a 209(b) state: with $1.3 billion in new sales, tobacco & business taxes former Gov.Warner (D) protected CHIP & the 80% FPL aged/disabled level; raised hospital, nursing home & dental rates; funded 850 more HCB waiver slots; covered 100,000 more children; added heart, diabetes & asthma programs; revamped the formulary; and sought $460 million more for HCB waivers. Yet home care agencies, doctors & dentists all complain that rates---including those for HCB & Katie Beckett waivers—are far too low. In spite of Gov.Tim Kaine’s (D) election, the GOP legislature seeks to create Medicaid health savings accounts; force more patients into HMOs (half are already); and, raise their cost-sharing.

Washington---the state reinstated 12 month Medicaid eligibility for children after over 20,000 lost coverage; dropped legal aliens from Medicaid & CHIP (but later reinstated many of them, is restoring even more & taking applications from others); cut Basic Health (state-subsidized insurance for those not on Medicare or Medicaid) enrollment from 130,000 to 100,000 & raised its premiums & co-pays; and set up a Medicaid “reform” commission. Even though added tobacco, gasoline & other taxes were voted in 2005, 63,000 patients lost Medicaid or CHIP. The state dropped plans for children’s Medicaid premiums; restored limited adult dental care; passed mental health insurance parity; found $82 million more for mental health & substance abuse services and will use a $14 million windfall from HHS to pay co-pays for Part D patients with incomes under 135% through 12/06. But faced with a half-billion dollar budget increase for Medicaid & related programs in 2007-09, Gov. Gregoire (D) will make administrative reforms; tighten prescription controls; and adopt case management for chronic, high-cost patients. For more 2003-05 details, see http://www.kff.org/medicaid/7314.cfm .

West Virginia---more tobacco taxes only briefly staved off Medicaid cuts & the state even had to cut its pitifully-low welfare grants by 25%. State officials called for $3 ER visit co-pays, a monthly limit of 4 brand name drugs & “health investment accounts” that also deter smoking & reward healthy lifestyles. There’s an ADAP waiting list, now that extra emergency federal funding has ended. A state health insurance risk pool was started but the state cut medical transport, incontinence, medical equipment & wheelchair supply funding & sought a waiver for a Medicaid “total re-design” & to cut its HCB waiver slots from 5,000 to 3,500. The legislature passed Gov. Manchin’s (D) bills to offer care to the uninsured poor for $1 co-pays at 8 clinics, sponsor an Appalachian Health Plan to offer cheap, but barebones, coverage to the working poor; and raise the CHIP income level from 200% to 300% (all to be effective in mid-2007). Yet a new rule mandates prior authorization even for oxygen & breathing machines, as does one already in force for adult patient diapers.

Wisconsin---in spite of big Medicaid budget deficits & financial spats between Gov. Doyle (D) & the GOP legislature, the state hasn’t made any notable Medicaid, BadgerCare or CHIP cuts (other than small co-pay increases); began covering prenatal & childbirth costs of undocumented immigrants & got its Pharmacy Plus waiver funding the Senior Care SPAP (which has a 240% income level) extended to 6/30/07, but failed to add SPAP coverage of the disabled. A state legislative committee is studying ways to cut Medicaid. With a small surplus in spite of rising & unexpected Medicaid costs, Gov. Doyle said he’d move 25% of nursing home patients into cheaper “family care” homes & HCB waiver care.

Wyoming---has no spend down; the state SPAP (once open to anyone--aged, disabled or not) now covers only non-Medicare eligibles (but does cover those disabled in the 2 year waiting period) under an income level of only 100%. A state committee began to study ways to cut Medicaid—and in 2006 the GOP legislature cut the mental health (including state hospital indigent mental health care for children) and substance abuse budget by nearly half-- even though the state’s new Healthy Together program already saved $15.6 million in un-needed ER visits & hospitalizations, just in the first half of 2005, by assigning care managers (RNs, social workers, etc.) to chronically ill & other Medicaid patients.

For the 48 states & DC, the 2006 federal poverty level (FPL) is $9800 yearly ($817 monthly) for one plus $3400 yearly ($283 monthly) for each additional person; levels are higher in Alaska & Hawaii.

See “State Assistance Programs for SSI Recipients, 2005” at www.ssa.gov/policy for states’ Medicaid eligibility policies for those on SSI, 209(b) status & amounts of (and who administers) state supplements; medically needy coverage; and state-SSA welfare interim assistance reimbursement agreements for those awaiting SSI decisions.

States’ August, 2003 cost-sharing, premium & co-pay rules & amounts appear in “Medicaid and SCHIP: States’ Premium and Cost Sharing” (03/04) at http://www.GAO.gov/new.items/d04491.pdf ; but even more recent data is in the “State Medicaid Prescription Drug Reimbursement Chart – March, 2005” at www.ascp.com .

See www.kff.org/medicaidbenefits for states’ 2003-04 coverage of chiropractors, podiatry, dentistry, dentures, orthodonture, eyeglasses, optometry, hearing aids, audiologists, psychologists, prosthetics, medical equipment, hospices and physical, occupational, speech & other therapy, which some states later cut in 2004-05.

See “Outline on State Medicaid Cutbacks & Responsive Advocacy” at www.healthlaw.org for legal rules states must meet to make cuts and legal arguments to oppose them. Guides and policy arguments for opposing state cuts appear at www.familiesusa.org , www.cbpp.org , www.communitycatalyst.org and www.TAEP.org .

See “ADAP Watch” at www.NASTAD.org for details on state ADAP waiting lists, cost containment measures & state ADAP websites. The “National ADAP Monitoring Report, 2006: Key ADAP Highlights”, Chart 1, pp.1-2, at www.kff.org lists all state ADAP income levels (almost all have asset levels too, which are at least as high as Medicaid’s; but they’re listed only on state websites; and see the full Report for Part D coordination measures, cost-sharing rules & medical criteria or prior authorization needed for special or costly drugs; state ADAP formularies appear in an adjacent document. See http://aidsinfo.nih.gov for a Glossary of HIV/AIDS words, terms & acronyms.

See “Pharmaceutical Benefits Under State Medical Assistance Programs, 2004” (Section 4, pp. 24-46) under “Resources” at www.npcnow.org for compilations of state Medicaid formularies, preferred drug lists, reimbursement data, over-the-counter (OTC) items coverage, prior authorization, prescribing/dispensing limits, drug utilization review and—above all—prescription cost-sharing, co-pay amounts and limits ; there’s even more current data in the “State Medicaid Prescription Drug Reimbursement Chart – March, 2005” at www.ascp.com .

See http://www.medicareadvocacy.org/AlertPDFs/07.21.05.PartDSpeak.full.pdf for a Glossary of Medicare Part D words, terms and acronyms; see “The New Medicare Drug Benefit: How Much Will You Pay?” at http://www.familiesusa.org/issues/medicare/rx-drug-center/benefit-basics.html for charts on Part D premiums, deductibles and co-pays---plus income and asset levels---for Low Income Subsidies/Extra Help.

See http://www.ncsl.org/programs/health/SPAPCoordination.htm for details about State Pharmacy Assistance Programs ( SPAPs) and their adaptations to & arrangements to coordinate with Medicare Part D drug plans.

See “Waiver Watch” at www.healthlaw.org and “Waiver Tool Box” at www.familiesusa.org for news and details on state waivers and proposed waivers.

See www.medicare.gov & www.cms.hhs.gov for CMS’ Part D data, enrollment & consumer tools; www.medicarerights.org , www.medicareadvocacy.org , www.NSCLC.org , www.healthlaw.org & www.TAEP.org on Part D advocacy; http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/04.Formulary.asp for CMS’ contact lists for 24 hour expedited & 72 hour standard coverage exceptions & appeals; and http://www.epocrates.com for regularly updated formularies for each Part D prescription drug plan.

While Part D displaces Medicaid for most drugs for dual eligibles, many drugs excluded by Part D—barbiturates; benzodiazepines; anorexia, weight loss & gain; cosmetic & hair growth; fertility; cough & cold; vitamins & minerals; and over-the-counter (OTC) remedies— can still be covered by state Medicaid programs (even for dual eligibles) & their coverage is re-tabulated---but still likely under-reported even here, given Title XIX’s “comparability’ rule--- from CMS surveys at www.medicareadvocacy.org/Part D_ExcludedDrugsbyState.htm (12/1/05 report under “News” icon).

See www.ncsl.org/programs/health/PartDPatch.htm , “States With Stopgap Measures” at www.healthassistancepartnership.org and http://www.kff.org/medicaid/7467.cfm for data on states’ emergency drug coverage for dual eligibles whose Part D plans don’t cover their drugs or who have other transition problems.

Email tomxix@ix.netcom.com for: “Painless” (alternative state Medicaid savings that don’t cut eligibility or benefits); listings of eligibility levels & rules in “States With Extra High Aged/Disabled Medicaid, SSP & Subsidized Health Insurance Income Levels” and “States With High Parental, Caretaker & Family Medicaid & Subsidized Health Insurance Income Levels”; for a “Glossary” of health policy and Medicaid terms and acronyms; and for ” SPAPs, Part D & Coverage of the Disabled”.