Alabama--- Only 12 doctor visits and hospital days are covered yearly; 4 brand name Rx’s are allowed monthly (but unlimited generics); and new SCHIP applications are again allowed. The 2007 Medicaid budget will be short $200 million. There’s an ADAP waiting list, only partially & temporarily served by now-expired extra emergency federal funding. For more 2003-05 details see http://www.kff.org/medicaid/7314.cfm .

Alaska---the state froze its Medicaid nursing home eligibility level at the current amount; cut the CHIP level from 200% to 175% (1,200 families lost children’s coverage) & “allowed” aged—but not disabled-- welfare recipients not on Medicaid to spend their checks on drugs at discounted Medicaid prices during thewait for Part D to start. The ADAP waiting list was only temporarily served by now-expired 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 ) $100 million in tobacco & income tax increases prevented elimination of the spend down, Katie Beckett waivers & coverage of eye exams & glasses for adults and nursing home payment cuts. The ADAP waiting list was only partially & temporarily met by now-expired emergency federal funding.

California--- new red tape & a reduced income level is taking 200,000 parents off the rolls. The Democratic legislature rejected almost all of Gov. Schwarzenegger’s ( R ) proposed cuts. But he proposed premiums ($4 to $27) for patients with incomes over 100% or the SSI/SSP level, is forcing the aged and disabled into HMOs (but the legislature postponed 500,000 of such transfers until at least 1/06), an annual patient dental care cap of $1,000 & an agreement with CMS on Medicaid DSH funding for $3.3 billion more in federal funds over 5 years (but advocates say this isn’t enough & doesn’t provide complimentary state matching funds). For more 2003-05 details, see http://www.kff.org/medicaid/7314.cfm . A Democratic bill to raise the CHIP level from 250% to 300% was expected to pass but is opposed by the Governor-- and the GOP has enough seats to sustain a veto.

Colorado---in 2005 a court voided a law to deny benefits to legal aliens & briefly-blocked CHIP applications were again accepted. A cut of Medicaid Rx’s to 8 a month--except for HIV, cancer & mental cases--fizzled after a physician outcry. Denver’s Medical Center & the University of Colorado Hospital cut their indigents’ care programs & raised their co-pays. Still, an added $2 million eased the state’s ADAP waiting list. Cigarette taxes raised by referendum will cover 4,000 more children, open 600 more HCB waiver slots to disabled children (which, due in part to CMS’ slow approval process, haven’t yet been opened, even as some current HCB cases are being incongruously closed), 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 coverage. And plans for a HIFA waiver were dropped. But the state plans to save $59 million by shifting children on Medicaid into HMOs. For more 2003-05 details see http://www.kff.org/medicaid/7314.cfm .

Connecticut—Governor Rell (R ) vetoed a bill to stop her from seeking a HIFA waiver and may again try to raise family Medicaid and CHIP premiums to between $10 and $50 monthly (an earlier attempt failed). The state 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 asset test; and required recoveries of SPAP costs from the estates of the deceased. It dropped legal aliens from welfare, Medicaid, CHIP and SAGA (state-funded welfare and medical programs). SAGA welfare was cut from $350 a month to $200; its patients will be forced into HMOs; and its medical budget was capped. The state ended coverage of chiropractic; naturopathy, occupational, physical & speech therapy; and psychology services for adults—but the Democratic legislature later repealed some cuts. Gov.Rell shelved plans to end waiver coverage for 16,000 CHIP parents; and the legislature might raise the parents’ level back up to the 185% children’s level.

Delaware---the state ended its waiver to give Medicaid to all uninsured adults under 100%.(except those on Medicare). The disabled’s SPAP coverage is capped, but the aged get added uncapped drug benefits from a separate, private statewide charity. In 2005, the state created a state income tax EITC.

District of Columbia---the DC-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 not-yet-implemented DC Rx Access law will offer Rx discounts to non-Medicaid patients.

Florida---Gov. Bush (R ) wants to out-source Medicaid, welfare and food stamp eligibility work to private contractors; and seeks a waiver to privatize Medicaid and convert it, using premium support and/or health savings account features, into a kind of private managed care insurance (a pilot plan is starting in Jacksonville and Ft. Lauderdale), although state and CMS officials still disagree on the plan’s DSH funding. State Medicaid officials plan to lower the aged/disabled income level from its current 88% to the SSI level, causing over 77,000 to lose coverage. Florida’s skimpy SPAP still excludes the disabled and there’s a new “fail first” Medicaid drug rule to cover some more costly mental health drugs only if cheaper formulary-preferred drugs first fail to work for a patient (but Lamictal, Paxil, Wellbutrin, Lexapro, Zoloft and Zyprexa are allowed). The state again accepts CHIP applications anytime instead of only two months a year; and, by late 2006, a new “SUNCAP” program will sign up SSI recipients for food stamps simultaneously, without the need to file at welfare offices too.

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 & other dental procedures. It lowered 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, for an estimated $42 million is savings) into HMOs (now delayed until 4/06); stopped covering adult dental care, orthotics, prosthetics & 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. After over 45,000 children had lost CHIP, Gov. Pedue (R ) sought CMS approval for a HIFA waiver to reduce nursing home access, raise Rx & other co-pays (even for children & nursing home patients), and add more managed care & health savings account features to Medicaid---but a state health  body did vote to ease the 90 day coverage suspensions for children with parents delinquent in paying CHIP premiums. The state’s ADAP has had to adopt some cost-containment measures. In July, 2005, CMS forbade further use of accounting gimmicks bringing in $300 million yearly in added federal funds. In August rising state revenues prompted the state to plan---with “free” help from the Elli Lilly Co.---much lesser cuts than the $269 to $388 million first projected.

Hawaii—a waiver gives Medicaid to all the uninsured under 200%, except for aged and disabled, who must be under 100% to get it. State law requires almost all employers offer health coverage to employees & dependents. 

Idaho---the state raised the CHIP level from 150% to 185% (but with less benefits and more co-pays than for others) and funded a pilot health plan for 1,000 adults, using newly-raised taxes. But it cut funds for a joint state-county medical program for the temporarily disabled and those awaiting SSA disability decisions. The ADAP waiting list was only partially & temporarily served by now-expired extra emergency federal funding.

Illinois---the state’s main SPAP (funded as a Medicaid Pharmacy Plus waiver expansion) 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 lead to making the disabled eligible for the main SPAP’s full formulary (possibly excepting anti-retroviral drugs) if a 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---while the Governor said he would cover 56,000 more persons in 2005. But the legislature voted a $70 million cut for HMO contracts and a Lewin study for the state projected 5 year savings of  $1.5 billion if the state forces all patients into HMOs (HMO enrollment has so far been voluntary in Illinois).

Indiana---the state’s SPAP still excludes the disabled; and, despite court suits, it still has a much-stricter-than-SSI “209(b)” Medicaid disability rule that one must be fatally or incurably ill. Gov. Daniels (formerly the GOP federal budget-cutting czar) once called for higher taxes on the rich to prevent Medicaid cuts---but was then silenced by criticism from right wing anti-tax zealots. The state plans to double CHIP premiums by early 2006.

Iowa---the state avoided cutbacks and even got a waiver to offer Medicaid to anyone---whether they’re aged, disabled, a 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). The ADAP waiting list was  only partially & temporarily served by now-expired extra emergency federal funding. By summer, 2005, a state legislative committee began studying ways to cut the Medicaid budget.

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. By summer, 2005, a legislative committee was studying ways to cut the Medicaid budget.

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 Rx co-pays to $1 per generic, $2 per preferred brand name and $3 per non-preferred brand name drug; and limited their monthly number (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, the ADAP waiting list was only partially & temporarily served by now-expired extra federal funding—and a Medicaid shortfall of $215 million just in state funds for fiscal 2006. That, and CMS’ decision to forbid the use of county hospital, clinic and nursing home budgets as non-federal matching funds, could cost the state $100 million and led it to seek $2 co-pays for office visits, $3 for other outpatient care, $6 for non-emergency ER visits and a whopping $50 per hospital stay for regular patients—and to seek waivers for co-pays of  $3 per generic, $10 for “preferred” brand name drugs and  $20  for “non-preferred” brand name drugs for spend downers.  

Louisiana---the state reduced allowed Rx’s from 8 to 6 monthly. 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 unable to pay). In 2005, there were even deeper provider rate cuts, the closure of 210 mental health and 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 after a $1-a-pack cigarette tax was defeated. The state has had to adopt some ADAP cost-containment measures; is considering banning condom coverage, (although federal Medicaid law requires family planning services and Louisiana has very high unwanted pregnancy and STD rates); and will extend formulary limits to mental health and hepatitis C drugs (they’d been exempt). CMS dropped its claim that the state owed it $340 million from past matching funds because of a questionable financing scheme.

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 adopted a formulary (with physician over-rides allowed). A large health deficit threatened coverage of adult dental care; hearing aids and tests, physical, occupational and speech therapy; psychological services; and prosthetics and orthotics. So the state raised income taxes on the rich & enacted or raised tobacco, alcohol, hotel, restaurant, car rental, soft drink & other taxes to help fund health care.

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 increases. He also dropped coverage for legal immigrant children (and pregnant women applying after 6/30/05) who’ve been here less than 5 years---but the veto-proof Democratic legislature may well reverse this too in early 2006. Yet the state still has 3 (!) generous SPAPs, just set up a high risk health insurance pool and, despite his anti-tax rhetoric, Ehrlich actually raised state property taxes & fees to help fund health budget growth.

Massachusetts---after 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 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 called for tougher work rules even for disabled welfare clients awaiting SSA disability awards-- and  limited state “Free Care” program patients’ ( those poor not eligible for Medicaid)  provider choice to low income clinics (rather than private doctors) & imposed $3 clinic& generic drug & $5 ER & brand name drug co-pays on them. The state may be forced to adopt ADAP cost containment by early 2006 & in September, 2005, an informal waiver giving the state $585 million extra in federal funds to match state funds from questionable financing schemes was expiring. 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. After the GOP legislature rejected liquor & estate tax increases, the GOP House majority then called for denying Medicaid to over 40,000 parents & childless, non-disabled 19- and 20-year-olds & appointed a task force to study ways to further cut Medicaid. A GOP Senate-passed bill would have not only denied coverage to many parents; closed 15,000 TANF cases & cut benefits for 60,000 more; it charges $5 monthly premiums to all non-pregnant, non-disabled adults; imposes co-pays of $10 for brand name drugs with generic equivalents; charges $2 co-pays for doctor visits, $25 for ER visits & $50 per hospitalization; and raises other Rx co-pays. After Gov. Granholm (D) called the GOP plans “unprecedented in [their] cruelty” she signed a bi-partisan compromise bill to grandfather-in current recipients; adopt the GOP Senate’s cost-sharing plan; & probably impose stricter eligibility rules for new applicants only or even mandate urine testing for smoking & sugary/fatty diets for non-disabled adults (who’ll then face $10 penalty premiums). But the state did restore coverage of adult dental care. The aged-only SPAP will be abolished when Medicare Part D drug coverage starts in 2006. For more 2003-05 details, see http://www.kff.org/medicaid/7314.cfm

Minnesota---after recently adding the disabled to its SPAP, the state raised premiums & co-pays for Medicaid, CHIP & MinnesotaCare and reduced the latter’s income levels; denied Medicaid & CHIP  to legal aliens; and ended medical supplies coverage for childless MinnesotaCare clients with incomes over 75%. But GOP plans to abolish the State General Medical Assistance Program (state medical care for the childless who are temporarily jobless or disabled and awaiting SSA disability decisions) and cut 30,000 from MinnesotaCare failed --and the cut MinnesotaCare medical supplies coverage was restored--after Gov.Pawlenty (R ) and the Democratic Senate agreed to a funding compromise to end a budget standoff that closed state offices by enacting a 75-cents-a-pack cigarette “impact fee”. A 2005 court order stopped a state attempt to allow providers to deny care to patients unable to meet co-pays. The state’s ADAP has already had to adopt some cost-containment measures.

Mississippi---the state 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 & mental patients, plus about 7,000 non-Medicare-qualified disabled clients, but lacks  funding for 2,000+ HIV patients losing Medicaid. After the state further cut brand name drugs to only 2 monthly (3 generics are also allowed) with no exceptions or appeals for more, officials at first promised HIV patients all the drugs they need, but then said that the Rx limits would shortly be applied even to HIV patients too.

Missouri---the state cut the aged/disabled income level from 100% to 85%; ended state medical & welfare programs for the temporarily disabled & 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 & many welfare-to-work parents; ended adult dentistry, hearing aid, crutches, wheelchair maintenance, walkers & eyeglasses benefits; enacted new & bigger Medicaid co-pays; ended CHIP’s co-pays but raised its premiums & required 46,000 previously-exempt children to now pay them; tightened medical qualifications for nursing home, HCB & home health care. While the SPAP wasn’t cut, it still excludes the disabled.  The state’s ADAP has had to adopt some cost-containment measures. By summer, 2005, a state legislative committee began studying how to cut Medicaid even more but health advocates started a petition for a referendum for 80-cents-a-pack more in cigarette taxes to restore some or all Medicaid cuts.

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 & tightened eligibility procedures to reduce enrollment---but did find money to end the CHIP waiting list. The state’s “Passport to Health” program is reported to save $20 million yearly by assigning primary care doctors to patients, reducing hospital costs. The state is seeking a HIFA waiver to fund a higher CHIP income level to cover 10,000 more children & give a watered-down Medicaid  to 3,000 more adults. The ADAP waiting list was only partially & temporarily served by now-expired extra emergency federal funding. An unexpected $12 million rise in CHIP costs could mean higher premiums or eligibility cuts in 2006

Nebraska----the state ended coverage for 15,000 welfare-to-work parents and childless, non-disabled 19 and 20-year-olds. The ADAP waiting list was only partially & temporarily served by now-expired extra emergency federal funding. By summer, 2005, a state legislative committee began studying ways to further cut Medicaid.

Nevada---the state ended the Medicaid income disregard of unemployment benefits & dropped plans to end the asset test for pregnant women & child-only coverage. Yet Gov. Gunn (R ) secured $1 billion in new taxes that helped fund Medicaid, adopted Ticket to Work Medicaid coverage for the working disabled, raised the aged-only SPAP’s income level (but failed to extend it to the disabled too), planned to use unspent CHIP money (with a waiver) and a CMS risk pool grant to subsidize health insurance for small employers’ workers & their dependents--but raised CHIP premiums. The state added $746,000 more to ADAP funding for 2006-07.

New Hampshire---the holdover GOP Medicaid Director continues to work with the GOP legislature, in spite of  some objections by Gov. Lynch (D), for a HIFA waiver to tighten up nursing home eligibility. Gov. Lynch (D)  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 & Medicaid changes that could complicate or undermine funding. The state’s ADAP had to adopt some cost-containment measures.

New Jersey---after previous cuts in the parental income level & dropping 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 CHIP, FamilyHealth & Medicaid.. Acting Governor Codey (D) signed a bilI to simplify red tape & to raise the parental FamilyHealth income level back up to 133%, enough to cover 80,000 more parents.

New Mexico--the state’s Medicaid waiver expansion to uninsured adults under 200% still excludes disabled & aged Medicare eligibles. The state 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 transport costs to get prescriptions; to end adult eyeglasses & 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---a “Family Health” waiver covers parents under 150% & childless (even non-disabled) adults under 100% but excludes childless Medicare patients (who must meet the lower SSI/SSP level to get Medicaid). State-subsidized health insurance for workers under 250% excludes part time workers & Medicare patients & caps yearly Rx bills at $3,000. The legislature failed to expand the aged-only SPAP to cover the disabled under 65; began forcing SSI recipients into HMOs; imposed a 9 month uninsured waiting period for, and forbade public employees from getting, Family Health; raised Family Health 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 co-pays at $200; adopted a preferred drug formulary with many consumer protections; raised nursing home & hospital taxes; is planning cheaper assisted living & adult day health care levels as alternatives to costlier full SNF-level care; and is still considering a HIFA waiver—to get $1.5 billion more in immediate federal funding-- that could water down benefits, raise co-pays & cut future federal funding. For more 2003-05 details see http://www.kff.org/medicaid/7314.cfm .

North Carolina---after the state earlier cut the Medicaid income level for pregnant women & infants from 185% to 151% & denied Medicaid to childless, non-disabled 19 & 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 have lost 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 services. But by late July a tentative final budget did not lower the aged/disabled income level or cut the 8,000 others off the rolls; but did limit Rx’s to 5 brand names monthly (with unlimited generics); and cut provider reimbursement. The state still excludes the disabled from its SPAP and an ADAP waiting list may be required again, since it was only partially & temporarily served by now-expired extra state and federal funding.

Ohio---the state cut the parental income level from 100% to 90% (27,000 are losing Medicaid); raised co-pays up to the $3 federal maximums; reduced the adult dental care budget by 50%; cut some vision, podiatry & psychologist services;  reduced Medicaid secondary payments for dual eligibles also on Medicare; ordered all parents, children & disabled not on Medicare into HMOs; slashed $80 million over 2 years from the non-federal Disability Medical Assistance for over 15,000 ill persons who are temporarily disabled or awaiting SSA disability decisions; allowed providers to refuse service to patients who don’t meet co-pays (even though it’s  against current federal law); but still created over 2,000 new HCB waiver slots. (Ohio’s aged/disabled Medicaid level—less than $500 monthly--has long been the nation’s lowest.) In summer, 2005, a state legislative committee began studying ways to further cut Medicaid.

Oklahoma---the state had already cut the Medicaid level from 185% to 100% for children over 1, and from 100% to 73% for the aged & disabled, ended the spend down for families & children, re-imposed a “3-Rx’s-a-month” limit and even cut the nursing home & HCB waiver income level down to $579 monthly. In 2005 Gov. Henry (D) added coverage of the breast and cervical cancer eligibility category but the GOP legislative leaders offered $63 million more in state oil revenues to raise hospital rates only if  $100 million in savings from “reforms” (i.e.,cuts) are made. The state’s ADAP has had to adopt some cost-containment measures. In summer, 2005, a state legislative committee began studying ways to further cut Medicaid.

Oregon---a losing tax referendum has caused 70,000+ childless, non-SSI adults and working poor parents to lose coverage through income level cuts & unaffordable premium increases & ended spend down eligibility for all but transplant & HIV patients (Oregon Health Plan enrollment fell over 50%). To carry out the legislature’s latest budget cuts, the state will limit adult dental care; end adult vision & all OTC pharmacy coverage; limit urban non-HMO in-hospital days to 18 yearly; and take more ADAP cost containment steps. On the other hand, the legislature enacted mental health/substance abuse parity for private health insurance.

Pennsylvania---budget shortages made the state close enrollments for state-subsidized health insurance for adults under 200% (which excludes Medicare patients & has no pharmacy benefit) and the state’s SPAP still fails to cover the disabled under age 65--even with huge savings from the federal $600 “interim” drug cards & the full Part D program. Gov. Rendell (D) & the GOP legislature agreed to premiums of $40+ monthly plus more & higher co-pays for Katie Becket waiver children in families earning over $40,000; and cutting inpatient hospital stays to twice a year, inpatient rehabilitation stays to once a year and doctor or clinic visits to 18 a year for adult male patients. But they rejected higher Rx co-pays & monthly numerical limits. The state will be forced to adopt ADAP cost containment measures by 3/06. The state’s Blue Cross plans (which are CHIP contractors) were found to be improperly enrolling poor children in their own $50-monthly-premium corporate “Special” plans---which, unlike CHIP, have no dental, vision, hearing or drug coverage—instead of  CHIP.

Rhode Island---the state resisted pressure 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 previously aged-only, limited-formulary SPAP & offered Ticket to Work Medicaid to 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 full 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 (its drug co-pays were already at the $3 ceiling). The state asked for CMS waivers to introduce Medicaid “debit card accounts” (a form of health savings accounts) to control costs; to set even higher co-pays (e.g., $5 per Rx, $100 per hospitalization. $25 per outpatient surgery); to deny coverage to non-disabled, childless 19- & 20-year olds; and to end EPSDT services at age 18—but then dropped the children’s waiver proposals in the face of a public outcry (advocates still have a court suit to block the whole waiver).

South Dakota---the state created a state Rx discount program for Medicare patients, and plans to establish a state high risk health insurance pool. The state’s ADAP had to adopt some cost-containment measures.

Tennessee----the state finally got federal court approval to end Tenncare coverage of 191,000+ aged, disabled,  parents and “uninsurable” childless, non-disabled adults with incomes who aren’t on SSI or TANF. The state will keep 97,000 “medically needy” patients covered, even though few of such over-income patients are ever able in practice to accumulate enough bills to successfully spend down. Children are exempt from cuts & some frail patients not on SSI or TANF will somehow be “grandfathered-in” for watered-down, private insurance-like coverage (with higher premiums, deductibles & co-pays than for those on residual Medicaid). Except for pregnant women, children & HIV+ or physically disabled persons, doctor’s visits will be limited to 10 yearly, hospital days to 45 & Rx’s to 2 brand names plus 3 generics monthly (the latter with  no exceptions & co-pays of $3; but without limiting HIV & Hepatitis C drugs). The state also adopted a formulary; will set ER co-pays at $5 (and even $5 for some brand name Rx’s if CMS agrees); raise co-pays still more for grandfathered, non-SSI, non-TANF adults ($10/$15 per Rx & up to $40 for doctors!); end methadone coverage; and offer aged/disabled ex-patients temporary Rx discount cards for up to 55 free generics (plus one brand-name anti-psychotic monthly for CMI patients) as token “sops”. The state budgeted (but is slowly distributing) $20 million more for low income & county clinics ($6 million at once), $5 million for post-transplant care & $3 million for cancer care of dropped Tenncare patients. The state will have to take ADAP cost containment measures by March, 2006.

Texas—In 2003-04 the state dropped its family-only spend down (single aged & disabled never could 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 much more; counted income for CHIP more strictly; imposed a 90 day wait to enroll in CHIP; reduced Medicaid home health care for the aged & disabled; and ended adult chiropractic & podiatry coverage. But a state “personal responsibility” law denying Medicaid to parents who abuse drugs or alcohol or whose children miss school, immunizations or medical or dental checkups was voided by a court. The state’s seeking a waiver to force TANF children & even the aged & disabled in the 8 largest counties into managed care, with a mandate to spend $109 million less  biennially on their care, but complex hospital rate issues are delaying forced managed care contracts for the aged & disabled. Texas  awarded $899 million to a private firm for food stamp, TANF & Medicaid eligibility work, causing 2,900 state worker layoffs & closing 100 welfare offices. Texas ADAP has had to adopt difficult & different negotiating strategies with drug companies for access to Fuzeon & other issues; but the legislature restored Medicaid and CHIP mental health, vision & hearing aid coverage and CHIP dental care. In August, 2005, a federal District court found the state in violation of a consent decree for improved EPSDT outreach. For more 2003-05 details, see http://www.kff.org/medicaid/7314.cfm.

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 & 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 & non-emergency dental care for non-disabled parents (which it will partially but only temporarily restore 10/1/05) and reduced chiropractic coverage. The state’s ADAP has had to adopt some cost-containment measures.

Vermont-- Gov. Douglas (R ) proposed an assets test for waiver coverage of higher income parents & childless adults (plus raising premiums on those with incomes over 50%) & for the state’s SPAP; and vetoed a bill to fund health care for the uninsured. But CMS will give him only $165 million more to meet Medicaid’s projected $400 million+  five year deficit in exchange for a “HIFA” waiver that would force enrollment in HMOs, promote HCB waiver care instead of costlier nursing homes but also cap future federal matching funds. The waiver must now be ratified by a legislative committee studying the question in late September, 2005.

Virginia---the state found funds to protect and streamline CHIP and preserve its recently-raised 80%-of-poverty aged/ disabled Medicaid level. Over $1.3 billion in new sales, tobacco and corporate taxes—but with a cut in the regressive food sales tax-- enabled the state to raise hospital and nursing home rates; maintain current eligibility levels; fund 700 more HCB waiver slots for the mentally-challenged; increase children’s dental reimbursements & coverage; and enroll 100,000 more children in Medicaid & CHIP. But the GOP legislative majority appointed a committee to study ways of cutting Medicaid & many Republican candidates are actually campaigning for Medicaid cuts in the November, 2005 legislative & gubernatorial election.

Washington---the state reinstated 12 month Medicaid eligibility for children; dropped legal aliens from non-emergency Medicaid and CHIP (but later reinstated 8,000 of the 27,000 dropped alien CHIP patients and might cover even more); and cut Basic Health (state-subsidized insurance for those ineligible for Medicare or Medicaid) enrollment from 130,000 to 100,000 and raised its premiums & co-pays. But since added tobacco, gasoline & other taxes to prevent cuts weren’t voted until 2005, 63,000 children lost Medicaid or CHIP. The state dropped plans for children’s Medicaid premiums; passed mental health insurance parity; and found $82 million more for mental health & substance abuse services, $24 million more for the homeless; and $100 million more for affordable housing. For more 2003-05 details, see http://www.kff.org/medicaid/7314.cfm .

West Virginia---a raised tobacco tax only briefly put off Medicaid cuts & the state even had to cut its already pitifully-low TANF welfare grants by 25%. With a $156 million shortfall for 2005-06, 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. The ADAP waiting list was only partially & temporarily served by now-expired extra emergency federal funding. West Virginia Access-- a state health insurance risk pool for those with pre-existing conditions who can’t get Medicare or Medicaid or buy affordable private coverage-- began to operate. Yet 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 about 5,000 to under 3,500.

Wisconsin---in spite of huge Medicaid budget deficits for 3+ years and continuing financial spats between the  Governor Doyle (D) & the GOP legislature, the state still hadn’t yet made any significant Medicaid, BadgerCare or CHIP cuts (other than small co-pay increases). The state is seeking CMS approval to force Medicaid & BadgerCare patients into HMOs. The state’s SPAP still excludes the disabled. By summer, 2005, a state legislative committee began studying ways to further cut Medicaid.

 Wyoming---the state replaced its SPAP (previously open to anyone--aged, disabled or not--under 100%) with a Pharmacy Plus waiver that, once approved by CMS, will now exclude those disabled still in their 2 year waiting periods. In summer, 2005, a state legislative committee began studying ways to cut the Medicaid budget.

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 .  But since then, many states have further increased cost-sharing, premiums and/or co-pays.

See www.kff.org/medicaidbenefits for states’ 2003-04 coverage of chiropractic, podiatry, adult dental, denture, eyeglass, optometrist, hearing aid, audiologist, non-M.D. psychologist,  prosthetic, medical equipment, hospice and physical & speech therapy services—which many states later cut in 2004 and 2005.

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

See “ADAP Watch” at www.NASTAD.org for details on state ADAP waiting lists and cost containment.

An outline of alternate state budget savings methods that don’t cut eligibility or benefits is available by emailing tomxix@ix.netcom.com .