2005 State Medicaid Eligibility Cutbacks: Proposed & Recently-Enacted By Thomas P. McCormack  [draft #  9,  July 5, 2005; please discard any earlier version]   Alabama--- despite huge Medicaid deficits, by 2005 the state had only a few cuts: Only 12 doctor visits and hospital days are covered yearly; 4 brand name Rx’s are allowed monthly (but unlimited generics); new SCHIP applications were briefly blocked; and even a tiny $3 monthly doctor’s fee to manage chronic cases was ended. In spite of huge, growing costs, the 2005 legislature failed to pass a Medicaid budget and the 2007 Medicaid budget will be short $200 million. There’s an ADAP waiting list, now partially and temporarily served by extra emergency federal funding. Alaska---the state froze its permanent CHIP and Medicaid nursing home income eligibility levels at current dollar amounts; lowered the CHIP level from 200% to 175% (1,200 families lost children’s coverage); and “allowed” those aged not on Medicaid yet nevertheless on public assistance—but, curiously, not the disabled--to spend their welfare checks on drugs at discounted Medicaid prices during the wait for Part D to start. There’s an ADAP waiting list, now partially and temporarily served by extra emergency federal funding. Arizona---while a waiver gives AHCCES (waiver Medicaid) to all uninsured persons under 200% , it unfairly excludes Medicare patients. Even though CMS did let the state impose higher co-pays (e.g., $10 per brand name Rx, $5 per generic, $5 per doctor visit), legal aid lawyers got a court order at least temporarily blocking them. Arkansas--- Gov. Huckabee’s (R ) successful fight for $100 million in tobacco and income tax increases has so far  prevented a second attempted elimination of  the spend down, “TEFRA” coverage of severely disabled children, coverage of eye exams and glasses for adults and eligibility and payment cuts for nursing home care. There’s an ADAP waiting list, now partially and temporarily served by extra emergency federal funding. California--- new red tape and a reduced income level will take 200,000 parents off the rolls. The legislature rejected almost all of Gov. Schwarzenegger’s ( R ) proposed cuts for  Crippled Children’s, ADAP and MediCal. But in early 2005, he proposed premiums ($4 to $27) for patients with incomes over 100% or the $812 SSI/SSP level, forced enrollment of the aged and disabled into HMOs, an annual patient cap of $1,000 for dental care and an agreement with CMS on Medicaid DSH funding that allegedly gains $3.3 billion more in federal funds over 5 years. But advocates say that this DSH funding isn’t enough, it doesn’t provide complimentary state matching funds and further locks in the unwise, forced enrollment of the aged and disabled into HMOs.. Colorado---in 2005 a law denying benefits to legal aliens was voided and briefly-blocked CHIP applications were again accepted. A rule to limit Medicaid Rx’s to 8 a month--except for HIV, cancer and mental cases--was dropped after a physician outcry. But Denver’s Medical Center and the University of Colorado Hospital cut their indigent care programs and raised their co-pays. Still, over $2 million was found to ease the state’s ADAP waiting list and the Governor will use large, new cigarette taxes recently voted to cover 4,000 more children, open 600 more HCB waiver slots to disabled children, give more funds to low income clinics, raise income levels enough to cover 90,000 more families, strengthen coverage of the aged and fund the new breast and cervical cancer Medicaid eligibility category. Connecticut—while Governor Rell (R ) still seeks a “HIFA” waiver and in late May, 2005 she vetoed a bill effectively prohibiting her doing so, legislative leaders may attempt to override it or add the ban to other bills. She may again attempt to raise family Medicaid and CHIP premiums to between $10 and $50 monthly, after an earlier attempted increase fizzled. The state already added co-pays of $1 to $3 for doctors; raised Medicaid’s $1 Rx co-pay to $1.50 and $3; upped SPAP premiums from $25 to $30 and its co-pays from $12/$15 to $16.25; imposed a $100,000 SPAP liquid asset test; and required recoveries of SPAP costs from estates of the deceased. It dropped legal aliens from welfare, Medicaid, CHIP and SAGA (state-funded welfare and medical programs). SAGA welfare was reduced from $350 a month to $200; its patients are being forced into HMOs; and its medical budget was capped. The state ended coverage of chiropractic; naturopathy, occupational, physical and speech therapy; and psychology services for adults---but many in the Democratic legislature now favor repeal of  the raised premiums and co-pays and benefit cuts. By May, 2005, the Governor shelved plans to end expanded waiver coverage for 16,000 working poor CHIP parents; some more taxes were enacted; and some legislators plan to raise the regular parental level back up to the 185% already used for certain children’s coverage. Delaware---the state still has a waiver to give Medicaid to all uninsured adults under 100%, except for  Medicare patients (who must be under the lower $579 SSI level to get Medicaid). Gov. Miner (D) has called for state-guaranteed health insurance for everyone with cancer. The disabled’s SPAP coverage is capped, while the aged are eligible for an additional uncapped drug benefit from a separate, private statewide charity. District of Columbia---the local, DC-funded Health Alliance still covers all uninsured persons under 200% except for Medicare and Medicaid eligibles; yet free city TB and STD clinics remain closed; and city low income clinics no longer give free Rx’s to the needy aged and disabled (who instead must be under 100% to get drugs from Medicaid). The DC Rx Access law offers discounts to those over 62 with incomes under 200% and to others under 350%; but eligibility, provider, delivery and cost-sharing details must still be worked out. Florida----the state continues to try to out-source Medicaid, welfare and food stamp eligibility work to private contractors; and, of course, there’s the still-being-developed proposal of Gov. Bush ( R ) to privatize Medicaid and convert it, using premium support and/or health savings account features, into a kind of private managed care insurance. He just signed a bill for a pilot version of the plan in the Jacksonville and Ft. Lauderdale areas. The state SPAP (it has quite skimpy benefits) still excludes the disabled under age 65 and a new Medicaid drug formulary and prior authorization rule has a “fail first” feature: To be covered, some more costly mental health drugs must not only secure physician-requested prior authorization--but cheaper formulary-preferred drugs must be shown to have already failed for that patient. On the other hand, the state will now accept CHIP applications all year long (they were limited previously to two 30 day periods a year). Georgia---the state ended spend downs to get nursing home care; lowered the CHIP income level from 235% to 200%; and stopped CHIP coverage of vision care, oral surgery and other dental procedures. It lowered the Medicaid and WIC level for pregnant women and infants from 235% to 185%, raised CHIP premiums from $10 monthly to $35, ended adult coverage for emergency dental care and artificial limbs and will force 800,000+ patients (including children, the aged and the disabled) into HMOs. The state had already stopped covering adult dental care, orthotics, prosthetics and hospice care; planned time limits on eligibility for patients in the breast/cervical cancer category; capped HCB expenses; increased red tape for CHIP enrollment; and added cost-sharing fees to Katie Beckett waiver care. By May, 2005—by which over 45,000 children had lost CHIP---Gov. Pedue (R ) sought CMS approval for a HIFA waiver to reduce nursing home access, raise Rx and other co-pays (even for children and nursing home patients), add more managed care and health savings account features to Medicaid and other economies in exchange for extra current funding (but which would bring federal matching fund caps that could cut future program funds).  But a state health  body did vote to ease the 3 month coverage suspensions for children whose parents are delinquent in paying CHIP premiums. The state’s ADAP has had to adopt some cost-containment measures. Hawaii—a waiver gives Medicaid to all the uninsured under 200%, except for aged and disabled, who must be under 100% to get it. Despite budget problems, the House passed a bill to create a Hawaii Rx Plus program like  Maine’s and to require employer health coverage for part-time workers. (State law already makes all but the smallest firms give health coverage to all employees--and their dependents—who work over 20 hours weekly.)  Idaho---the state raised the CHIP level from 150% to 185% (but with less benefits and more co-pays for new patients) and funded a pilot health plan for 1,000 adults---paid for by higher taxes. But it cut funds for a joint state-county medical program for the temporarily disabled and those awaiting SSA disability decisions. There’s an ADAP waiting list, now only partially and temporarily served by extra emergency federal funding. Illinois---the state’s main SPAP (funded as a Medicaid Pharmacy Plus waiver expansion to about 200% FPL) originally excluded the disabled  (although they could get a very limited formulary from the smaller Circuit Breaker SPAP); but a bill signed by Gov. Blagjoevich (D) 6/29/05 could eventually lead to making the disabled eligible for something like the main SPAP’s full formulary (with the possible exception of anti-retroviral drugs) if the state’s planned waiver to do so is approved by CMS. The state also raised the parental income level to 185%, enacted a dedicated hospital tax to help fund Medicaid and eased application red tape. But the legislature did vote a $70 million cut for managed care contracts and a Lewin consultant study for the state projected 5 year savings of  $1.5 billion if the state forces all patients into HMOs (enrollment is now voluntary in Illinois). Indiana---the state’s SPAP covers only the aged and not the disabled; and, despite court challenges, it still has a much-stricter-than-SSI “209(b)” Medicaid disability rule that one must be fatally or incurably ill. Even Gov. Daniels (formerly the GOP federal budget-cutting czar) once sought--but has since done nothing to get the Republican legislature to pass--higher income taxes on the wealthy to help prevent Medicaid shortfalls. Iowa---the state avoided cutbacks and even got a waiver to offer Medicaid to anyone---aged, disabled, parent or not ---with income under 200% (with providers limited to a few selected hospitals; a cap of 30,000 new recipients; and possibly a limited, or even only manufacturer-donated, drug benefit). There’s an ADAP waiting list, now partially and temporarily served by extra emergency federal funding. Kansas---the state SPAP covers only those over age 67 but not the disabled. Rejecting Gov. Sibelius’ (D) call for wider health coverage, the GOP legislature passed only token health insurance “reforms”, a limited tax credit to expand small firm health coverage, health savings account measures and a health care re-organization plan. The state will be forced to adopt ADAP cost containment measures by March, 2006. Kentucky--- the state already made rate cuts for pregnancy and well-baby care, immunizations and screening services at county clinics; hired a PBM to reduce Rx costs and a “disease management” firm for other savings; raised the $1 Rx co-pay to $2 and $3 for brand name drugs; and limited the number of monthly Rx’s (with appeals allowed). But it dropped previously-tightened nursing home and HCB care medical qualification rules; and even reinstated 2,500 mentally ill former clients. Still, there’s an ADAP waiting list--now partially and temporarily relieved by extra federal funding—and a Medicaid shortfall of $215 million just in state funds for fiscal 2006. That, and a recent CMS decision to prevent the use of county hospital, clinic and nursing home budgets to meet the non-federal Medicaid matching share that could cost the state $100 million, have convinced officials to require $2 co-pays for office visits, $3 for other outpatient care, $6 for ER visits and $50 per hospitalization for ongoing eligibles—but $3 per generic, $10 for “preferred” brand name drugs and  a whopping $20  for “non-preferred” brand name drugs for spend downers; and to seek a waiver for even more cost-sharing and service limitations.   Louisiana---the state reduced allowed Rx’s from 8 to 6 monthly (a doctor’s signature can bypass the 6-a-month limit; but overriding the new “absolute” limit of 8 requires appeal to a state body). An attempt died to impose a 200% of poverty eligibility level for getting free care from the State Charity Hospital System (which, since its creation by Huey Long in the 1920s, has accepted anyone claiming an inability to pay). In 2005, there were even deeper provider rate cuts, the closure of 210 mental health and other disability centers, the ending of many Charity Hospital services, reductions in school health care and adoption of a formulary. A new hospital tax-- designed to generate $200 million more in state and federal funds--passed in early June, after a $1-a-pack cigarette tax was defeated. The state’s ADAP has had to adopt some cost-containment measures and the state is  even considering banning coverage of condoms---even though federal Medicaid law requires family planning services and Louisiana has very high rates for both unwanted children and venereal disease and extending its formulary limits to mental health and hepatitis C drugs, which have so far been exempt. Maine---the state enacted partially state-subsidized health insurance for small employers’ workers and their families; raised the Medicaid income level for childless adults (including the aged and disabled) to 125% and for parents to 200%; and a formulary (with physician over-rides allowed). Yet a large health deficit could end coverage of adult dental care; hearing aids; hearing tests; physical, occupational and speech therapy; psychological services; and prosthetics and orthotics and bring even worse cuts. To help meet these funding needs, as of June, 2005 Gov. Baldacci (D) and the Democratic legislature were about to lower income taxes on the working poor while raising them for the rich; lower property taxes for modest income homeowner and renter families; and raise tobacco, alcohol, hotel, restaurant, car rental, soft drink and other taxes.  Maryland---almost all of the Governor Ehrlich’s (R ) proposed 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 increases. And in June, 2005 he was considering dropping pregnant women and children with less than 5 years’  legal residence. Yet the state still has three (!) generous SPAPs, just set up a high risk health insurance pool and, despite anti-tax rhetoric, increased state property taxes and fees have helped fund health budget increases. Massachusetts---almost all of Gov. Romney’s  (R ) health cut proposals failed or were reversed by the  Democratic legislature. (The state still offers the most generous eligibility in the nation.) For details see “Funding Cuts in Massachusetts..” at www.sihp.brandeis.edu/mhpf. By 2005, even Gov. Romney proposed moving toward universal health coverage by voluntarily urging purchase of cheap, limited benefit, high cost-sharing policies by the uninsured and more enrollment in Medicaid by all those eligible. He even wants a higher minimum wage for firms that don’t offer health insurance and agreed to a Combined Application Program (CAP) to give food stamps automatically to SSI recipients, without the need for separate applications at welfare offices. Still, the state may be forced to adopt ADAP cost containment measures by March, 2006. Michigan--- the state excluded parents from medically needy (but not cash welfare-based) Medicaid, then this was blocked by a court order. But, even with raised tobacco and nearly-doubled hospital taxes going to Medicaid, it still had to end almost all Medicaid adult dental, hearing aid, podiatry and chiropractic care. When liquor and estate tax increases failed to pass the legislature, the GOP’s House-passed budget then called for denying Medicaid to over 40,000 parents and related caretakers of poor children and childless, non-disabled 19- and 20-year-olds. Gov. Granholm (D) wants big provider rate cuts--with doctors exempt if a 2.3% gross revenue tax on them passes---while a Senate-passed GOP bill would ban new enrollments even of non-disabled parents; drop 10,000 TANF cases; impose premiums of at least $5 monthly on all Medicaid patients but the pregnant, the disabled and children; and impose co-pays of $10 for brand name drugs with generic equivalents, put co-pays on some other drugs and charge $3 for doctor and $25 for ER visits (with some cost-sharing waived for those who diet, exercise or stop smoking). The Governor called the GOP plans “unprecedented in [their] cruelty” and threatened vetoes. The state SPAP still excludes the disabled under age 65. Minnesota---after recently extending its SPAP to cover the disabled too, the state raised premiums and co-pays for Medicaid, CHIP and MinnesotaCare and reduced the latter’s income levels; denied Medicaid and CHIP  to legal aliens; ended medical supplies coverage (and capped outpatient care at $5,000 yearly) for childless MinnesotaCare clients with incomes over 75%; and made other cuts. But GOP plans to abolish the State General Medical Assistance Program (state-funded medical care for the childless temporarily unemployed and disabled and those awaiting SSA disability decisions) were dropped after both parties agreed to keep funding it at lower levels by shifting some of its patients to the separately-funded MinnesotaCare. Still, Gov. Pawlenty (R ) plans to drop 30,000 patients from the latter program unless the Democratic Senate accepts a GOP plan to raise funds from a new state-sponsored casino (and he’s also offered to accept a 75 cent-a-pack cigarette tax hike); the Democrats instead want an income tax increase for the wealthy (which the Governor and Republicans, of course, oppose). So on July 1, 2005 the lack of a budget suspended all “non-emergency” state services (just as in the 1995-96 federal budget standoff crisis that closed the federal government). After Pawlenty tried to suspend even state-funded medical services as “non-essential” without a budget, a local state court order forbade any such stoppages. The state’s ADAP has already had to adopt some cost-containment measures. Mississippi---the state, over big protests, lowered its aged and disabled Medicaid level from 135% ($1,068 monthly for one) to $579---causing 65,000 aged and disabled to lose Medicaid; and reduced monthly Rx’s from 7 to 4 brand names plus 4 generics. The state says it has a waiver to keep using the old, higher aged/disabled level for transplant, dialysis, chemo and mental patients, plus about 7,000 non-Medicare-qualified disabled clients, but it has no ADAP or other funding for the 2,000+ disabled HIV patients losing Medicaid.  After state  officials further limited brand name prescriptions to only 2 monthly, on June 30 , 2005, they added that they’d still somehow arrange for HIV patients to still get all the drugs they need. Missouri---the state cut the aged/disabled income level from 100% to 85%; ended state medical and welfare programs for the temporarily disabled and those awaiting SSA disability decisions; ended Ticket to Work Medicaid for the working disabled; cut the parents’ income level to 23% from 75%; dropped coverage of non-custodial parents paying child support and many welfare-to-work parents; ended adult dentistry, hearing aid and eyeglass benefits; enacted new and increased Medicaid and CHIP co-pays; raised CHIP premiums; tightened medical qualifications for nursing home and HCB care; and cut home health benefits. While the SPAP wasn’t cut, it still excludes the disabled. Nearly 100,000 Missourians will lose health coverage by July, 2005. The state’s ADAP has had to adopt some cost-containment measures. Montana---the state added more and bigger co-pays to Medicaid and CHIP, slashed TANF (welfare) grants, restricted nursing home eligibility, cut doctor visits for the aged and disabled to 10 yearly, dropped coverage of some hospice and home health care and tightened eligibility procedures to reduce and retard enrollment---but did find money to end the CHIP waiting list. In early 2005, the state was apparently seeking a HIFA waiver to get federal funds to raise its CHIP income level to cover 10,000 more children and to give a watered-down Medicaid  to 3,000 more adults. (But such a waiver could reduce future federal Medicaid funding.) There’s an ADAP waiting list, now partially and temporarily served by extra emergency federal funding. Nebraska----the state ended coverage for 15,000 welfare-to-work parents and non-disabled 19 and 20-year-olds. There’s an ADAP waiting list, now partially and temporarily served by extra emergency federal funding. Nevada---the state ended the Medicaid income disregard of unemployment insurance and dropped plans to end the asset test for pregnant women and child-only coverage. Yet Gov. Gunn (R ) secured $1 billion in new taxes that helped stop more Medicaid cuts, adopted Ticket to Work Medicaid coverage for the working disabled, found funds to raise the SPAP income level (but failed to extend it to the disabled too), planned using unspent CHIP money (under a waiver) and CMS risk pool grant funds to start subsidized health insurance for small employers’ workers and their dependents; yet he still raised CHIP premiums. In May, 2005, the Democratic House voted to somehow expand coverage to some persons under 150%; but the bill now faces a GOP Senate and Governor. The legislature did add $746,000 more in state ADAP funding for the coming biennium. New Hampshire---in May, 2005, the GOP legislature was considering plans to increase CHIP cost-sharing and to tighten up nursing home and HCB services eligibility. But only the legislature---and not the Governor alone---can authorize a Medicaid HIFA waiver that some state officials have long sought. Gov. Lynch’s (D) inaugural speech called for more CHIP enrollment; he fulfilled a campaign pledge for $180,000 more in state ADAP funds; and the legislature voted a 28 cents-a-pack cigarette tax increase---but tied it to highway toll and Medicaid changes that could bring a veto. The state’s ADAP had to adopt some cost-containment measures. New Jersey---after previous reductions in the parental income level and ending coverage for otherwise-eligible legal aliens, the state also ended hospital payments in its non-federal medical program for the temporarily disabled or those awaiting SSA disability decisions. In January, 2005, the state signed a contract to privatize eligibility determinations for the CHIP and FamilyHealth Medicaid programs previously done by state workers. In late June, 2005, the state Senate voted unanimously to liberalize FamilyHealth rules enough to cover 80,000 more parents; the House is expected to agree; and so is the Acting Governor (he’s also a Senator). New Mexico--the state’s Medicaid waiver expansion to uninsured adults under 200% still excludes disabled and aged Medicare eligibles. The state plans to--or if necessary is seeking waivers to--impose co-pays of $2 per Rx, $5 per office visit, $15 per ER visit and $25 per hospital admission ; to require an “enrollment fee” of $25 and a $10 annual premium; to eliminate transport costs to get prescriptions; to end eyeglasses and other medical equipment coverage; and to end non-emergency coverage for illegal aliens. Even with such savings, the legislature is still considering new hospital and HMO taxes (a 2.5% drop in the state’s FMAP doesn’t help). New York---while a “Family Health” Medicaid waiver covers parents under 150% and childless (even non-disabled) adults under 100%, it excludes childless Medicare patients (who must meet the lower SSI/SSP level to get Medicaid). State-subsidized Healthy NY insurance for workers under 250% excludes part time workers and Medicare patients and caps yearly Rx bills at $3,000. In 2005, the state rejected a proposal to extend SPAP coverage to the disabled under 65; began mandatorily moving SSI recipients into managed care; imposed a 9 month uninsured waiting period for, and forbade public employees from getting, Family Health; raised its co-pays to $5 for doctors and dentists (but with a $25 yearly dental co-pay cap), and to $3 for generic, and $6 for brand name, Rx’s; ended non-clinic podiatrist coverage; raised other Medicaid Rx co-pays to $1 per generic and $3 for brands; adopted a preferred drug formulary with many consumer protections; raised nursing home and hospital taxes; couldn’t decide what to require from non-profit health plans which convert to for-profits; and planned a HIFA waiver—in order to get $1.5 billion more in immediate federal funding-- that could water down the benefit package, raise co-pays and possibly reduce future federal funding. North Carolina---after the state cut the Medicaid income level for pregnant women and infants from 185% to 151% and denied Medicaid to childless, non-disabled 19 and 20 year-olds, it still found $2.765 million in fiscal 2005 funds to cover those on its long ADAP waiting list. In May, the state Senate voted to cut the aged/disabled Medicaid level from 100% to 74% (57,000 would lose coverage, with 5,000 more to be somehow exempted from the cut); to drop 8,000 others from Medicaid; to add $1 million in fiscal 2006 to ADAP; to limit all Rx’s, brand or generic, to 8 monthly; and (over Governor Easley’s protest) to heavily slash home attendant care services. But in June the House budget did not lower the aged/disabled income level or cut the 8,000 others off the rolls; with only 5 brand name Rx’s allowed monthly (but unlimited generics); and with some provider reimbursement reductions. The state still excludes the disabled from its SPAP and an ADAP waiting list may be required again, since it’s now only partially and temporarily relieved by extra state and federal funding. Ohio---in late June, 2005, a bill nearing passage in the Republican legislature--and apparently backed by GOP Gov. Taft --will cut the parental income level from 100% to between 70% and 90% (causing 25,000 to lose Medicaid), raise co-pays up to the $3 federal maximums, allow reductions in adult dental, vision, podiatry and psychologist services and seriously cut if not abolish non-federal Disability Medical Assistance for over 15,000 ill persons who are temporarily disabled or awaiting SSA disability decisions. (Ohio’s aged/disabled Medicaid level--about $450 monthly--has long been the nation’s lowest.) The state will even cut between $57 million and $200 million from county eligibility determination budgets for Medicaid, welfare and food stamps. Oklahoma---the state had already cut the Medicaid level from 185% to 100% for children over age 1, and from 100% to 74% for the aged and disabled, ended the spend down for families and children, re-imposed a “3-prescriptions-a-month” limit and even cut the nursing home and HCB waiver income level down to SSI’s level ($579). In 2005 Gov. Henry (D) added coverage of women with breast and cervical cancers or precursors but the GOP legislative leadership offered to appropriate $63 million more in state oil revenues for higher Medicaid hospital payments only if  $100 million in savings from “reforms” (often a code word for cuts) are made.  The state’s ADAP has had to adopt some cost-containment measures. Oregon---a losing tax referendum cost childless adults not on SSI their Medicaid benefits except for a possibly only temporary, watered-down package, and parents with income over welfare levels but below 185% were dropped too; the vote also ended the medically needy spend down for all but transplant and HIV patients. Increased cost-sharing in what remains of the Oregon Health Plan has caused enrollment to drop about 50%. The state will be forced to adopt ADAP cost containment measures by March, 2006. Pennsylvania---budget shortages made the state close enrollments for its very inexpensive state-sponsored health insurance for adults under 200% (but it excludes Medicare patients and has no pharmacy benefit). And the state’s SPAP still fails to cover the needy disabled under age 65 too--even though the state is projected to save $150 million in 2004-05 just from the federal $600 “interim” drug cards and will save much more from Part D’s start. To meet a $495 million Medicaid deficit, Gov. Rendell (D) and the GOP legislature preliminarily agreed in early July, 2005, to premiums of $40 monthly and up for families earning over $40,000 with disabled children on Katie Beckett waivers and more and higher co-pays for them; cutting some hospital rates; and possibly limiting  inpatient hospital stays to twice a year, inpatient rehabilitation stays to once a year and doctor or clinic visits to 18 a year for patients other than women and children; but they dropped planned increases for Rx co-pays and limits on covered drugs . The state will be forced to adopt ADAP cost containment measures by March, 2006. In June, 2005, the state’s Blue Cross plans (which are CHIP contractors) were reported to be improperly enrolling poor children in their own $50-monthly-premium “Special” plans---which, unlike CHIP, have no dental, vision, hearing or drug coverage—instead of  CHIP. Rhode Island---amid many calls for closing enrollment or cutting the 185% parental income level for RIghtCare (a waivered Medicaid/CHIP expansion), the state added limited coverage of the disabled over 55 to its previously aged-only, limited-formulary SPAP and Ticket to Work Medicaid for the working disabled. South Carolina----a state waiver gives Medicaid drugs (but not other Medicaid benefits) to those between 100% to 200%--but only to the aged, not the disabled (who must be under 100% to get Medicaid). The state also raised co-pays for some families on Medicaid and CHIP; reduced covered Medicaid Rx’s from 4 to 3 monthly; and added co-pays of  $2 for doctor visits; $3 for dentists; $3 for medical equipment; and $1 for optometrists, chiropractors and podiatrists; and already charged the maximum $3 drug co-pay). The state applied for a CMS  waiver to introduce Medicaid “debit card accounts” (a form of health savings accounts) to control costs; such recipient accounts would then be drawn down on to pay even higher co-pays (e.g., $5 per brand or generic Rx, $100 per hospitalization) until accounts are depleted, when patients might still face the raised co-pays. South Dakota---the state created a state-sponsored prescription discount program for Medicare patients, and was planning to establish a state high risk health insurance pool. The state’s ADAP has had to adopt some cost-containment measures. Tennessee----in May, 2005-- as the state was awaiting final federal court approval to end Tenncare coverage of 323,000 aged, disabled, parents and even uninsurable childless, pre-disabled adults under 400% who are not on SSI or TANF or are children—the Governor offered to keep 97,000 “medically needy” patients on the rolls, but didn’t detail precisely who they are or on what exact basis their eligibility will continue. Children are exempt from cuts, and some frail patients not on SSI or TANF will somehow be “grandfathered-in” for watered-down, private  insurance-like coverage (with higher premiums, deductibles and co-pays than for those on residual Medicaid). Except for pregnant women, children and HIV+ or physically disabled persons, doctor’s visits will be limited to 10 yearly, hospital days to 45 and Rx’s to 3 brand names plus 4 generics monthly, with co-pays of $3. The state also adopted a formulary and will raise ER co-pays $5 (and even $5 for some brand name Rx’s if approved by CMS); raise co-pays still more for grandfathered, non-SSI, non-TANF adults ($10/$15 per Rx and up to $40 for doctors!); end methadone clinic coverage; and offer Rx discount cards, some limited, temporary drug bill payments and token continuing case management for the terminated aged and mentally ill as consolation prize “sops”. The state will be forced to adopt ADAP cost containment measures by March, 2006. Texas—In 2003-04 the state dropped its family-only spend down (single aged and disabled never could spend down); ended CHIP coverage of prostheses, physical therapy and private duty nursing; tightened CHIP asset rules; imposed $10 to $20 co-pays for CHIP doctor visits and Rx’s; raised CHIP premiums much higher; counted income for CHIP more strictly; imposed a 90 day wait to enroll in CHIP; reduced Medicaid home health care for the aged and disabled; and ended adult eyeglasses, hearing aid, chiropractic, podiatry and (some) mental health coverage. But the state “personal responsibility” law denying Medicaid to parents who abuse drugs or alcohol or whose children are truant or miss immunizations or medical or dental checkups was voided by a court. By June, 2005, Gov. Perry (R ) expected to sign a bill to seek a waiver to require the shifting of recipients in the 8 largest counties into managed care plans, with a mandate to spend $109 million less biennially on their care; the state’s ADAP has had to adopt some cost-containment measures; but the legislature restored Medicaid and CHIP mental health, vision and hearing aid coverage and CHIP dental care. Utah---the state continues to have a “HIFA” waiver to give watered-down Medicaid (no in-hospital, specialists’, nursing home, home health or other ancillary services; extra-high drug and other co-pays) to all uninsured adults under 150% --except for disabled and aged Medicare eligibles (who must be under 100% to get full, regular Medicaid). The state also ended Medicaid coverage for adults of podiatry, speech therapy, audiology, occupational therapy, physical therapy, vision and much adult dental care and reduced chiropractic coverage. The state’s ADAP has had to adopt some cost-containment measures. Vermont-- Gov. Douglas (R ) proposed adding an assets test for waiver coverage of parents and childless adults with higher incomes (plus placing higher premiums on those with incomes over 50%) and for the state’s SPAP. In June, 2005, he got CMS approval for what appears to be a “HIFA” waiver to promote HCB services as less costly alternatives to nursing homes---but such waivers can often water down covered services,  require bigger co-pays than Medicaid allows and can cut future federal funding. The state House voted to end adult eyeglasses and dental coverage but the Senate hasn’t yet acted on the bill. Virginia---the state found funds to protect and streamline CHIP and preserve the state’s 80%-of-poverty aged/ disabled Medicaid level. In 2005, over $1.3 billion in new sales, tobacco and corporate taxes enabled Virginia Medicaid to raise hospital and nursing home rates; maintain current eligibility levels; fund 700 more HCB  waiver slots for the mentally-challenged; and enroll 100,000 more children in Medicaid and CHIP. Washington---[tentative report; awaiting clarifications from state health sources] the state added red tape barriers to Medicaid and CHIP to cut enrollment; ended phone applications; dropped legal aliens from non-emergency Medicaid and CHIP; and excluded childless adults from the state-subsidized Basic Health Plan for non-Medicare patients under 200% and raised its co-pays. See http://fortress.wa.gov/dshs/maa/Programchanges2003/ for details on earlier cuts. In spite of more tobacco, gasoline and other taxes voted in 2005, 25,000 single adults lost Basic Health, 63,000 children lost Medicaid or CHIP and thousands more aged and disabled lost Medicaid. The state even plans to forbid county mental health centers from cross-subsidizing care for the totally uninsured poor with Medicaid payments they receive. West Virginia---Former Gov. Wise’s (D) proposal to raise the tobacco tax and dedicate it to forestalling looming Medicaid deficits was passed by the legislature; but it met rising Medicaid budget shortages for only one year and the state even had to cut its already pitifully-low TANF welfare payments by 25%. Faced with a  $156 million shortfall for 2005-06, state Medicaid officials called for $3 ER visit co-pays, a limit of 4 brand name drugs and “health investment accounts”  that also deter smoking and reward healthy lifestyles. There’s an ADAP waiting list, now partially and temporarily served by extra emergency federal funding. Wisconsin---in spite of huge Medicaid budget deficits for 3+ years and continuing financial spats between the Democratic Governor and the GOP legislature, the state still hadn’t yet made any significant Medicaid or CHIP cuts (other than small co-pay increases), until the Capital Times reported 6/7/05 that, with a biennial Medicaid deficit of at least $645 million, the legislature’s GOP leadership was considering unspecified cuts to BadgerCare (a Medicaid/CHIP waiver expansion for parents and children under 185%) and to the state SPAP (which still excludes the disabled under age 65), but then only days later it simply deferred any cuts, perhaps indefinitely. Meanwhile, the state is seeking CMS approval to force Medicaid and BadgerCare patients into HMOs and considering whether, or to what extent, to continue its SPAP now that Part D drug coverage is about to start.  Wyoming---the state passed a bill to replace its SPAP (previously open to anyone--aged, disabled or not--under 100%) with a Pharmacy Plus waiver that, once approved by CMS, will give Medicaid drugs only to Medicare patients under 175% (thus now excluding those disabled still in their 2 year waiting periods). For the 48 states & DC, the 2005 poverty level is $9570 yearly ($798 monthly) for one plus $3260 yearly ($272 monthly) for each additional family member; levels are higher in Alaska & Hawaii (see www.dhhs.gov ).   States’ August, 2003 cost-sharing, premium and co-pay rules and amounts for Medicaid and SCHIP patients are set forth in “Medicaid and SCHIP: States’ Premium and Cost Sharing…” (March, 2004) at www.GAO.gov .  Since then, many states have further increased cost-sharing, premiums and/or co-pays. See “Outline on State Medicaid Cutbacks and Responsive Advocacy” at www.healthlaw.org for legal rules states must satisfy in making cutbacks and legal arguments to oppose them. Useful guides and arguments for opposing state cutbacks appear at www.familiesusa.org , www.cbpp.org , www.kff.org and  www.americanprogress.org---and anti-cutback materials at www.TAEP.org  are especially comprehensive. An outline of alternative state budget saving techniques that don’t involve eligibility or benefits cutbacks is available by emailing tomxix@ix.netcom.com . Details on state ADAP waiting lists and cost containment cutbacks are available in the “Latest ADAP Watch” at www.NASTAD.org .