States, including California, are implementing a variety of strategies to control rising Medicaid (Medi-Cal in California) costs while also looking ahead to a major expansion of the state-federal health insurance program for the poor beginning in 2014. To cope with the rising costs, states are pushing Medicaid recipients into managed-care plans run by private insurers, cutting reimbursement rates to hospitals and doctors, and reducing benefits. In addition, the faltering economy is driving more jobless Americans into Medicaid; thus, increasing enrollment at the same time that medical costs keep rising. The new federal health law mandates states to maintain Medicaid eligibility and enrollment standards until 2014, when the expansion begins to add 16 million Americans to the program. However, states are still free to cut optional benefits, which include drugs, vision care as well as visits to certain providers such as chiropractors and podiatrists. The most restrictive proposal is that of Hawaii; the Aloha State plans to cut hospital stays under Medicaid to 10 days a year. This month, Nebraska began limiting how many adult diapers it pays for to 180 a month. In July, Colorado stopped covering circumcisions. California stopped that coverage decades ago. Tennessee terminated coverage of adult acne medicine.
As of November, California plans to eliminate adult day-care coverage and limit Medicaid patients to seven doctor visits a year, as of November. In October, North Carolina stopped covering regular eye examinations and eye glasses for adults in Medicaid. In July, Connecticut cut the number of dental exams covered for adults in Medicaid from twice a year to once a year. Pennsylvania began requiring adult Medicaid patients to get state permission for crowns and certain other dental procedures.
“The benefit cuts are indicative of the real cost pressures on states and that there are only so many things you can do to address them,” said Stacey Mazer, senior staff associate at the National Association of State Budget Officers.
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