ࡱ>  @ -0bjbj)) %KzKz$v($$$8`#`#`#8#|*T8l@*."../L1Z11$R$K 1 1@KK./&WWWK&.8.WKWW5q )t.* p6'`#@Sr"D<0l sVVD)t88)t$u 1V(:W@D:11188#D8Wj88#Medicaid Watch: State Medicaid and Health Cuts & Expansions Thomas P. McCormack, Editor [draft # 6; May 31, 2009; please discard earlier versions] See pages 13 and 14 for updated sources and resources on state health programs NATIONAL SNAPSHOT SUMMARY States made or are considering cuts or expansions in AL, AR, CA, CO, CT, DC, FL, GA, ID, IL, IN, KS, LA, ME, MD, MI, MN, MO, MT, NE, NV, NJ, NY, NM, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, WA, WV & WI Almost all states already pay far-too-low fees to MDs, DDSs, hospitals & nursing homes; and now many are moving to slash those rates even lower. Some states have monthly numerical limits on Medicaid Rxswith very strict & low monthly caps in AL, AR, GA, KY, LA, MS, OK, SC, TX and WV Most states deny non-emergency dental care---often even denturesto adults. There are ADAP waiting lists in IN, MT & NE and now or soon in ID, KY, ME, PR & VI, while AL faces a $2-$12 million budget cut & enrollment cap State Pharmaceutical Asst. Programs (SPAPs) in AK, IN, NC, NY, PA, SC & WI exclude disabled & HI, IL, MD, MO, MT & RI deny them full coverage 21 of the 35 state-subsidized health insurance high risk poolsstill fail to permanently fund subsidized discount premiums for lower income patients. Alabama--has no spend down; an aged/disabled level of $674/mo (the SSI rate), a parent level of 11%/ 25% if working (2008); CHIPs level is 200% & ADAPs is 250%; covers j12 MD visits & hospital days/yr & 4 brand Rxs/mo; and has an ADAP enrollment cap. The deficit is $784 million & Gov. Riley (R) asked the legislature (D) to cut CHIP $5.3 million & HIV care $2+ million (it did so, thus threatening $10 million more in federal funds) & freeze CHIP enrollment The risk pool has no low income premium discount or Medicare supplement. The legislature is considering a 5.8% hospital fee to fund Medicaid Alaska---this Title XVI state has no spend down; an aged/disabled level of about $1,036 (its SSI/SSP rate), a parent level of 80%/85% if working (2008) & a 300% ADAP level. It tightened HCB & home care medical qualification rules; has a risk pool with a Medicare supplement but no low income premium discount; created a token SPAP for those under 175% that excludes the disabled; and covered some adult dentistry. Gov. Palin (R) & the legislature (R House; tied Senate) raised the CHIP level to 175% of Alaskas own FPL. Arizona--has no spend down or risk pool &covers parents under 200% & childless (even non-disabled) adults under 100%, its CHIP level is 200% and ADAPs is 300%.With no objections by incoming Gov Brewer, the legislature (both R) killed ex-Gov. Napolitanos (D) program to let the disabled buy into Medicaid during Medicares 2 yr waiting period & cut home personal care services for the aged & disabled. The 2010 deficit is $3 billion. A bill to raise the CHIP level to 350% (with sliding scale premiums) died in the legislature Arkansashas an aged/disabled level of $674 (the SSI rate), a parent level of 14%/17% if working (2008), an ADAP level of 500% & a monthly numerical Rx limit. A waiver subsidizes insurance for small firm workers below 200%. Gov. Beebe & the legislature (both D) raised DDS fees, covered most adult dentistry and passed a 56 cent cigarette tax to fund low income clinics & raise the CHIP level from 200 to 250%. The risk pool has no low income premium discount or Medicare supplement. Health staff say Medicaid & CHIP need $111 million more in 2010. California--The under-funded risk pool (often closed to new patients) has no low income premium discount or Medicare supplement. Public Citizen says MD fees are the US 10th lowest. The state covers the aged/disabled under about 135%, parents below 100%/106% if working & prostate cancer patients under 200%. Its ADAP level is 400% & CHIPs is 250% Gov. Schwarzenegger (R) stopped paying Medicare HMO premiums for dual eligibles. He & the House (D) agreed on a bill to cover children below 300% & adults under 100%/150%; and to subsidize insurance for others below 400%--but, with a $24 billion deficit, the Senate (D) killed it. He raised family premiums; capped adult & child dentistry at $1,800 & $1,500/yr; made families re-apply each 6 months; cut provider fees 10% (but courts barred hospital, Rx & adult day health care cuts); and ceased paying Pt B premiums for Medicare patients on spend downs of over $500/mo. He proposes to deny non-emergency care to legal aliens, cut the parent level to 72%, drop 2nd, non-unemployed parents, slash pay for home care workers $2+/hr & cut ADAP & HIV care by $55.5 million (possibly imposing patient cost-sharing for Rxs). 429,000 may lose coverage---plus up to 1.5 million children due to a funding referendums 5/09 defeat. Sacramento Co is closing 2 public clinics & some counties bar illegals from their clinics. A court says CA is ignoring a law making it cover the HIV+ pre-disabled with any savings from moving HIV clients into HMOs; but it says HMOs cost more than fee-for-service care Colorado---has no spend down. The old GOP legislature gutted the insurance minimum benefits law & promoted HSAs in private plans, but raised the parent level to 60%/66% if working (2008). The level for those over age 60 is $699 (the SSI/SSP rate only for them) but a mere $674/mo (the SSI rate) for the younger disabled. The ADAP level is 400%. The Denver Med. Ctr. & the U. of CO Hosp. cut their indigent care programs; and they & the stats Indigent program (for the childless poor awaiting SSA disability awards) boosted co-pays. The state raised the risk pool low income premium discount level to $50,000 & added a Medicare supplement to it. Gov. Ritter (D) adopted a formulary; joined a multi-state Rx buyer pool; and made private plans cover PTSD, anorexia, substance abuse & colorectal screening. A reform panel big coverage expansions, but the deficit is now $300 million+---so the state cut MD fees 2% & low income clinic subsidies $15 million. Yet Ritter & the legislature (D) passed a hospital fee to raise $600 million more for Medicaid, CHIP & the CO Indigent Care Program to cover over 100,000 more persons, boost the 225% CHIP level to 250% and the parent & childless (even non-disabled) adult levels to 100%, offer Medicaid to the working disabled under 450% and double hospital indigent care funding,--phased in over 2 years. They widened CHIP psychiatric benefits, started a SPAP just for HIV patients & allowed HMOs to sell cheap, but barebones, coverage to limited income uninsured & unemployed persons Commonwealth of the Northern Marianasfederal law caps its matching rate below what states get & it cant even fully fund its share of Medicaid even though 37% of residents are poor enough for Medicaid. Its low fees attract few MDs & DDSs (only public clinics), but it enrolled some off-island specialists by agreeing to pay Hawaiis higher Medicaid fees Connecticuta 209(b) state; its aged/disabled level is about $842 (its SSI/SSP rate), its parent level is 185% (191% if wking) & its ADAP level is 400%; its CHIP level is 300% and its risk pool has a low income premium discount for those under 200% but no Medicare supplement. Ex-Gov. Rowland or Gov. Rell (both R) raised premiums, co-pays & asset levels for the SPAP (its income levels are $25,100 for 1 & $32,900 for 2); ended non-clinic-provided adult chiropractor, naturopath, psychologist and occupational, physical & speech therapy coverage; and extended hospice care to all Medicaid patients; but MD & DDS fees are still too low. Rell moved to cut AIDS services by $2.7 million & the SPAP by $2.8 million and delay the start of an HIV HCB waiver to save $4.6 million. She proposed raising CHIP premiums & co-pays, ending coverage of non-emergency adult dentistry & legal aliens in the country under 5 years; and cutting coverage for SPAP clients not yet on Medicare (i.e., the disabled still in Medicares 2 year waiting period). For more details on her proposed health cuts see  HYPERLINK "http://www.cthealthpolicy.org/pdfs/gov_budget_impact.pdf" http://www.cthealthpolicy.org/pdfs/gov_budget_impact.pdf . The legislature (D) covered the working disabled & made private plans let children stay covered to age 26. A freedom of information dispute caused 2 HMOs to end state contracts. Rell wants to force families back into contract HMOs to fund her skimpy, state-subsidized insurance plan for those under 300%. It has high co-pays, limited psychiatric care, low yearly caps on Rx & medical equipment costs, a $100,000/yr cap on all benefits & a $1 million lifetime cap. The House passed a bill to allow merger of the state worker plan, Medicaid & CHIP into 1 state-run plan open to the uninsured and small firm, non-profit & localities workers, and voted for its own universal plan. Both bills are expected to pass the Senate, but face probable Rell vetoes. The state dropped its QI asset test & raised QMBs income level to 207%; SLMBs to 227% & QIs to 242%--thus qualifying almost all SPAP clients for full Pt D Extra Help too. The biennial state deficit is $8 billion Delaware---has no spend down or risk pool; covers all (even childless & non-disabled) adults under 100%/106% if working and has a 500% ADAP level and 200% CHIP & SPAP levels. Ex-Gov. Minner, Gov. Markell & the legislature (all D) started a cancer care program for those under 650% & funded state medical assistance program for others under 200%; raised provider fees; and covered the working disabled. The legislature is considering letting over-income children buy into CHIP for premiums priced at the full, unsubsidized cost. Fiscal 2010s deficit is projected to be $600 million District of Columbia---has no risk pool. Income levels are 200% for parents, 100% for the childless aged & disabled, 300% for CHIP & 400% for ADAP. DCs own local non-federal health program covers all others under 200%. Mayor Fenty & the Council (both D) covered adult dentistry; raised substance abuse funding & dental fees (but other provider rates remain too low); boosted the aged/disabled asset level $2,000 & the QMB income level to 300%; dropped the QMB asset test (the last 2 changes qualified many DC Medicare patients for Pt Ds full Extra Help); and enacted a bill to subsidize insurance for others under 300%..The Fiscal 2010 deficit is projected to be $806 million, so DC had to postpone plans for provider fee raises & subsidized insurance. It made $51 million in grants to subsidize & expand low income primary care; but mandated pre-authorization for pain, gastrointestinal & insulin Rxs (even though MDs & druggists strongly object) and began replacing public mental health clinic services with services from private contractor providers Florida---Ex-Gov. Bush & the legislature (both R) got a waiver to privatize Medicaid, using premium support & HMOs. A court let HMO patients disenroll for good cause. The under-funded risk poollong closed to new patients--has a Medicare supplement but no low income premium discount. The state cut the aged/disabled level from 88% to the $674/mo SSI rate, but grandfathered -in those under 88% who are in HCB care or not on Medicare. The parent level is 21%/55% if working (2008) & ADAPs is 300%. The state covers dentures (but little other adult dentistry) & hearing aids. Gov. Crist (R) started an Rx discount plan; cut HMO fees $60 million; dropped Zyprexa from the formulary; and proposed letting children over CHIPs 200% level buy in at cost. He also signed bills to make private plans cover autism care & let children be covered until 30; gut the insurance minimum benefits law; sponsor cheap, barebones policies for the uninsured (see  HYPERLINK "http://www.coverfloridahealthcare.com" www.coverfloridahealthcare.com ); drop hospice & cut dialysis care; cut mental health & substance abuse funds & MD fees; put more clients in HMOs; and cut Medicaid $803 million. See  HYPERLINK "http://www.hpi.georgetown.edu/floridamedicaid" www.hpi.georgetown.edu/florida &  HYPERLINK "http://www.floridachain.org" www.floridachain.org and FL Medicaid Waiver .. at  HYPERLINK "http://www.kff.org" www.kff.org & New ..FL. Health Plans at  HYPERLINK "http://www.cbpp.org" www.cbpp.org The Medicaid chief suggested dropping 7,800 18, 19 & 20-yr-olds & 6,800 pregnant women; the legislature cut hospital rates, home & HCB care waiting lists are long, Polk Co. dropped 12,000 from its own medical aid program, & Pasco Co. used up specialist consult funds for low income patients. Crist restored $22 million for care of aged & disabled clients, medical care for 900 special needs children and mental health & substance abuse benefits. He & GOP House leaders oppose a Senate-drafted $1 cigarette tax to raise $1 billion for Medicaid. The legislature was considering requiring that Medigap policies be sold to the disabled just as they are to the aged & covering the working disabled. But it is only now realizing that an obscure CMS waiver clause requires big coverage expansions by 2011 to avoid losing $300 million in US funds Georgia---has no risk pool. Its aged/disabled level is only $674/mo (the SSI rate), its parent level is 29%/52% if working (2008), ADAPs is 300% & CHIPs is 235%. It has a monthly numerical limit on Rxs; ended CHIPs dental surgery coverage & raised its premiums; ended coverage of adult emergency dentistry & artificial limbs and nursing home spend downs; and tightened Katie Beckett waiver admission rules. Gov. Perdue & the legislature (both R) herded patients into HMOs (but permit opt outs) & ended suspensions for late CHIP premiums Added red tape cut child enrollment 100,000. Provider fees are too low. Atlantas Grady Hosp. & Savannahs Mem. Health Univ. Hosp. are short many millions due to unpaid indigent care, so Grady will close 3 of its 9 neighborhood clinics & cut its free indigent care level from 250% to 125% (with discounts for those under 200%). With a $2 billion deficit, Perdue dropped planned HMO, hospital & provider fee raises; was considering a $1.2 million ADAP cut; called for a $186 million hospital payment cut, proposed new taxes & fines to meet CHIP, Medicaid & hospital trauma costs & is considering privatizing much of public mental health care; but signed a bill subsidizing insurance for low wage small firm workers.(Discounted but high premiums will buy only basic, high deductible policies requiring HSA deposits). See New GA ..Health Plans.. at  HYPERLINK "http://www.cbpp.org" www.cbpp.org Guamthis territorys matching funds are capped by law far below what states get. Its local medically indigent program (MIP) pays even less than Medicaid & has almost no private providers. Scanty funds for off-island specialty care & air transport to it run out quickly. Provider fees are too low & paid too late. Only 1 dentist takes Medicaid & CHIP patients Hawaiia 209(b) state with no risk pool & a waiver covers all parents & other non-Medicare adults (even the childless & non-disabled) below 200%. The childless aged/disabled level is only 100% of HIs own FPL & ADAPs is 400%. The state makes all employers insure workers & dependents, covered the working disabled and has a SPAP only for Medicare patients under 100%. Gov. Lingle (R) & the legislature (D) raised the CHIP (to 300%) & parent (to 250%) levels; restored some adult dentistry; ended CHIP premiums but, facing a deficit, dropped premium-free CHIP for over-income children. The legislature (D) then voted to restore that coverage (which Lingle opposes) by funding it in several wider, hard-to-veto appropriation bills. The state is herding 37,000 aged & disabled into 2 for-profit HMOs that advocates say are sub-par Idaho---a Title XVI state, with no spend down; an aged/disabled level of about $706 (the SSI/SSP rate), a parent level of 22%/28% if working (2008); an ADAP level of 200%; and a risk pool with no Medicare supplement or low income premium discount. The GOP legislature raised the CHIP level from 150% to 185%; subsidizes a little-used pilot plan for poor (even childless & non-disabled) adults & small firm workers; covered the working disabled; and got CMS to allow 3 patient classes: Parents & children; the disabled & chronic cases; and the aged---who may get differing benefits or more co-pays but also more preventive care. Gov. Otter (R) covered adult dentistry. An audit said 100+ case eligibility errors go un-corrected monthly. A big deficit forced Otter to cut hospital & rehab facility fees by 55% (which a court then barred), and occupational & speech therapy; mental health and partial care funding. The deficit may require an ADAP waiting list; but Otter pledged to support a health panels suggestion that the state foster affordable private insurance for those aged 25 to 65. He froze nursing home, ICF, MD & DDS fees and stopped covering non-emergency transportation to care. Illinois---this 209(b) states aged/disabled level is 100% but its main SPAP excludes the disabled, who get only a limited formulary from a 2nd,SPAP (both have 200% levels). Ex-Gov. Blagjoevich, Gov. Quinn & the legislature (all D) added HIV drugs to the 2nd SPAPs formulary (for Medicare patients only); but the huge state deficit derailed their plans to give all disabled full, equal benefits in the main SPAP. They raised the parent level to 185%, set the ADAP level at 400%, accepted a court order to raise pediatric fees (yet other state fees are too low & paid very late; although the state pledged to pay off a huge claims backlog by 6/1), offered subsidized insurance to veterans left uncovered by VA cuts & raised the CHIP level from 200 to 300%. The under-funded risk pool, often closed to new patients, has a Medicare supplement but no low income premium discount. Blagjoevich proposed raising the parent level to 300% & CHIPs to 400% (but keeping it at just 100% for all childless adults, even aged & disabled ones) and subsidizing insurance for others under 400%--but later scaled back his plan to fully subsidize only those under 100%; with more cost-sharing & lower subsidies up to 300%. He did resist forcing patients into HMOs, raised the working disabled level to 350%, made private plans let children stay covered to age 26; required that Medigap policies be sold to the disabled as cheaply as the costliest ones for the aged are sold & ordered an $8 million raise in pediatric specialist fees. A $150 million Cook Co. Hospital system shortfall threatened service cuts, facility closures, denial of free care to poor suburbanites & imposition of Rx co-pays that the county mostly averted with higher taxes; but a $100 million shortfall forced the U. of Chicago Medical Center to close its womens & dental clinics and budget shortages forced the U. of IL at Chicago to close a clinic too. The legislature found $640 million to subsidize safety net hospitals (with $51 million for Cook Co.Hosp) & made hospitals give discounts to the uninsured and it funded a hospital assessment plan to attract $450 million more in federal matching. Gov. Quinn (D) supported most Blagjoevich health policies, but with reservations about the adult eligibility expansions to 300% & 400%. Indiana---this 209(b) states token SPAP for those under 150% excludes the disabled; and it has a much-stricter-than-SSI 209(b) Medicaid disability rule (one must be fatally or incurably ill). The regular parental level is 20%/26% if working (2008). Gov. Daniels (R) & the then-all-GOP legislature raised CHIP premiums, but let Medicare patients enroll in the risk pool (which has a low income premium discount) for secondary coverage. The ACLU filed suit against an only-once- every-6-yrs denture & re-linings limit. Poverty advocates & the House (now D) oppose Daniels eligibility privatization of Medicaid, food stamps & welfare (now stalled but once underway in 59 of INs 92 counties), which they say deters access to help & leaves fewer clients eligible, even as the recession caseload rises. ADAP (with a 300% level) has a waiting list. The state tightened its lax Medicaid spend down (but a court reinstated 12,606 wrongly-dropped clients) and raised the CHIP level from 200 to 300%. A waiver subsidizes insurance for parents below 200%--and it even has up to 37,000 slots open to childless, non-disabled adults under 65 (for which over 100,000 of them have already applied). But the aged /disabled levelnow under $620/mo, the US 2nd lowest---wont rise. The insurance offers HMOs, preventive care, few co-pays; but no dental or vision care. Patients must put 2%-4% of income into HSAs. Even richer non-Medicare adults can buy in at full cost. See  HYPERLINK "http://www.cbpp.org/1-24-08health.htm" http://www.cbpp.org/1-24-08health.htm , Healthy IN Plan. at  HYPERLINK "http://www.kff.org" www.kff.org & Profiles: Healthy IN Plan.. at  HYPERLINK "http://www.statecoverage.net" www.statecoverage.net . Theres a $763 million deficit (but the state also a $1.4 billion unspent surplus), Daniels pledged not to cut eligibility, yet will cut MD, DDS, nursing home & hospital fees 5%. The 17- hospital St. Vincent system eased its free care & discount rules for indigents & debtors. The Senate (R) was blocking a House (D) bill to spend $23 million on breast & cervical cancer screening because of allegations that it also widens abortion access Iowa---a waiver covers up to 30,000 non-Medicare adultseven childless & non-disabledunder 200% for care & Rxs only at 2 public hospitals. The aged/disabled level is $674/mo (the SSI rate), the parent level is 29%/86% if working (2008) & ADAPs is 200%. The risk pool has a Medicare supplement but no low income premium discount. The deficit is $350 million. Gov. Culver & the legislature (both D) made private plans let children stay enrolled to age 25, covered disabled children under 300% through the FOA and are raising the 250% CHIP level to 300% & letting any otherwise-insured children who still lack dental coverage buy into CHIP dentistry benefits only. He supports bills to let localities, small firms (dropped by the House) & non-profits join the state worker health plan; but sought a $10 million Medicaid cut Kansas---this Title XVI state has an aged/disabled level of $674/mo (the SSI rate), a parent level of 27%/34% if working (2008), a 200% CHIP level & a 300% ADAP level. The legislature (R) passed a bill promoting HSAs & raised provider fees to 65%-83% of Medicares. Blue Cross & a foundation subsidize insurance for KC-area families under $30,000. The risk pool has no low income premium discount or Medicare supplement. Ex-Gov. Sibelius (D) covered the working disabled, ex- disabled & some pre-disabled, offered state mini-COBRA rights, raised low income clinic subsidies & signed bills authorizing Medicaid for parents under 50% by 2009 & all adults under 100% by 2012 and to study insurance subsidies for those under 200%. The legislature funded raising the CHIP level to 250%, but refused to increase tobacco taxes to fund the scheduled parent & adult coverage expansions too. Gov. Parkinson (D) favors program cuts as well as more taxes to meet a $238 million deficit. There are 10,000 backlogged applications & yearly re-determinations. Kentucky--- has an aged/disabled level of $674/mo (the SSI rate), a parent level of 36%/62% if working (2008), a 200% CHIP level & a 300% ADAP level. The legislature (R Sen.; D House) dropped tough, yet unworkable, nursing home & HCB medical admission rules; capped Rxs at only 4/mo, limited occ./phys./speech therapy, x-rays & MRIs; raised co-pays; and divide Medicaid into 4 different groups: healthy adults; children; aged & disabled; and MR & DD patients: See  HYPERLINK "http://www.kff.org/7530.cfm" http://www.kff.org/7530.cfm . The state raised child DDS fees. The risk pool has no low income premium discount or Medicare supplement. Gov. Brashear (D) faces a $456 million deficit, with an increase in Medicaid/CHIP costs of $242.5 million in 2010. He signed a 60 cents tobacco tax to prevent Medicaid cuts, but an ADAP waiting list may be needed. Louisiana---has an aged/disabled level of only $674/mo (the SSI rate), a parent level of 12%/26% if working (2008) & an ADAP level of 200% Its risk pool has no low income discount or Medicare supplement. The legislature (D) voted to raise CHIPs 250% level to 300% (which Bushs CMS cut to 250%). Gov. Jindal (R) agreed to a 10% raise in CHIP funding; urged HHS to forgive a $771 million over-payment; and seeks a waiver to move patients into HMOs & use DSH--and even some Charity Hosp--funds to subsidize insurance for parents below 50% in N.O., Baton Rouge & Shreveport plus all adults below 200% in Lake Charles. See LA Health First at  HYPERLINK "http://www.dhh.louisiana.gov" www.dhh.louisiana.gov & LAs Medicaid Waiver.. at  HYPERLINK "http://www.cbpp.org" www.cbpp.org Legislative leaders insist on reviewing any waiver before implementation.& MD groups fear the waiver may harm Charity Hosp. system finances (theyre already short $81 million, LSUs charity hospitals face a $25 million legislative budget cut). Jindal proposed $531 million in health cuts, including reducing covered Rxs from 8 to 5 monthly (unless more are medically justified) & a 7% MD fee cut .He plans to refuse $9.5 million in US stimulus funds for coverage of parents leaving welfare to go to work & for DSH funding for hospitals that treat the indigent & uninsured, while the legislature is considering a $200 million hospital rate cut. LAs Medicaid & CHIP matching rates will fall 9% by 2011, cutting funding more. But $737 million in other federal funds are still going to LA hospitals, especially in N.O. Maine---Gov. Baldacci & the legislature (both D) subsidize insurance for those under 300% (its premiums were at first too high & it was under-funded & under-enrolled in) and raised the childless adult Medicaid level to 100% (but new non-disabled, non-aged patients are excluded) & for parents to 200%/206% if working. The state has a 500% ADAP level, a 200% CHIP level & SPAP levels of $1,604/mo for 1 & $2,159/mo for 2 and gives O/P waiver coverage to HIV+ (even pre-disabled) patients under 250%. Theres no risk pool. Baldacci proposed an employer play or pay rule, reforming hospital funding and starting risk pool & reinsurance plans. Adult dentistry is limited (but dentures are covered). There are no MSP asset tests and the QMB income level is 150%, SLMBs is 170% & QIs is 185%. Baldacci raised cost-sharing for those over 150%, cut podiatry care, imposed $25 premiums on richer clients & adopted ADAP economies. With a $140 million deficit, Baldacci said Medicaid was $65 million over budget just in FY 2009, while the legislature made $34 million in health & welfare cuts, and he may make $25 million more in health cuts & even start an ADAP waiting list Maryland---has an aged/disabled level of only $674/mo (the SSI rate), a parent level of 116%, a CHIP level of 300% & an ADAP level of 500%. An appeals court upheld AARPs & Legal Aids suit to widen the states overly-strict nursing home, HCB waiver & at-home care medical qualification & appeal rules. A waiver merged the main SPAP with a state O/P low income clinic program into one care & Rx program for all non-Medicare adults (even childless & non-disabled) under 116%. A state-sponsored, Blue Cross-run 2nd SPAP (with a 300% level) covers some Part D donut hole costs & premium costs, but it seems to exclude the disabled. Provider fees are too low. One childs untreated tooth infection spread to his brain & killed him, so UnitedHealth funded an indigent child care program at the state dental school. The risk pool has low income premium discounts for those under 200% but no Medicare supplement; and the state covers the working disabled. Gov. OMalley & the legislature (both D) made private plans let children stay covered to 26; raised the income level to 116% for full Medicaid for parents; began to subsidize insurance for some low paid small firm workers & gave $50 million to prevent closing of Prince Georges Co. Hosp, ,where 1/2 of patients are indigents---and Baltimores Bon Secours Hosp., where indigents run up huge unpaid care costs too, has asked for $5 million to avert closure. The state cut Medicaid $82 million, including nursing home, home health aide, private RN & HMO fees and community services funds for the disabled. With a $1.9 billion deficit, OMalley may delay or cancel a planned 7/09 Medicaid expansion to 116% for childless adults, but is funding a $42 million child dental fee raise, will carve child dental coverage out of HMOs to be run directly by Medicaid and signed bills making hospitals give free care to those with incomes under 150% & help patients in applying for medical assistance & coverage. Patients of overcrowded Baltimore clinics are spilling over into ERs. Blue Cross staff & some legislators proposed a $1.6 billion universal coverage plan with low income subsidies. Massachusetts---has no risk pool. Ex-Gov. Romney (R) signed the legislatures (D) bill to expand Medicaid; require everyone to have insurance; subsidize it for small employers & workers under 300%; increase the CHIP level from 200% to 400%; and raise the parentsbut not the childless aged (now only 100%) & disabled (now only 133%) Medicaid level to 200%. The ADAP level is 488% & the SPAPs is 188% (but up to 500% if one is on Pt D too). Gov. Patrick (D) cut cost -sharing for Free Care state-only-funded patients under 200%. Theres a $1.2+ billion deficit, so he then raised Medicaid & other subsidized health programs premiums & cost-sharing. See On the Road..at  HYPERLINK "http://www.urban.org" www.urban.org on the reforms. Advocates are seeking to widen the insurance minimum benefits law to cover more mental health care. Theres a growing waiting list to get home care aides. Patrick raised SPAP cost-sharing by $11 million; and proposed to freeze MD & hospital fees; and cut $74 million for substance abuse, tobacco cessation & school RNs and $20 million for pregnancy prevention & dental care. Even before the federal stimulus bill began COBRA subsidies, MA did so for those under 400% Michigan---has no risk pool; an aged/disabled level of 100%, a parent level of 39%/66% if working (2008), a CHIP level of 200% (with no childrens Medicaid or CHIP asset test) & an ADAP level of 450%. It ended most adult dental, hearing aid, podiatry & chiropractic coverage and stopped enrolling childless non-disabled adults under100% into its O/P care-only waiver. Gov. Granholm (D) & the then-all-GOP legislature added cost sharing---but (only temporarily) restored adult dentistry; and raised child wellness & dental and adult preventive care fees. Genesee (Flint), Ingram (Lansing), Muskegon & Wayne (Detroit) Counties subsidize coverage for workers under 200%. With 2010s deficit doubling to $1.32 billion, Granholm & the legislature (R-Sen; D-House), whod previously passed big tax raises & budget cuts, agreed on $300+ million in cuts: a 4% MD rate cut (yet they raised HMOs MD fees $198 million, but cut overall HMO rates $7.7 million) & dropped (for at least 5 months) adult dental, vision, chiropractic & podiatry benefits. The legislature is considering bi-partisan bills to raise the adult Medicaid level to 200%, subsidize insurance for those between 200 & 300%, offer state re-insurance for claims from $25,000 to $250,000 & ban insurance denials or higher premiums for chronic condition patients Minnesota---this 209(b) state has an aged/disabled level of about 100%, a CHIP level of 275%, an ADAP level of 300% and a risk pool with low income premium discounts for those under 200% & a Medicare supplement. It raised premiums & co-pays for Medicaid, CHIP & MinnesotaCare (Medicaid-subsidized insurance for parents & other adults under 275%) and denied Medicaid & CHIP to legal aliens. ADAP co-pays were ended. Gov. Pawlenty (R) funded an Rx discount plan for uninsured & Pt D donut hole patients; and covered the working disabled, ex-disabled & some pre-disabled. The legislature (D) banned hospitals from pre-screening patients for unpaid medical debt. Pawlenty wouldnt adopt a study panels whole expansion plan, but did agree to raise the childless non-Medicare adult Minnesota Care level to 250% & cut its premiums. With a $4.63 billion deficit, he cut hospital rates $90 million, capped enrollment in HCB care for the disabled, but pledged to protect child health benefits. For the 2010-11 biennium, he then proposed cutting the budget for personal aides for the disabled & tightening medical qualifications & hours of coverage for aides (affecting 2,100 patients); tightening medical qualifications for nursing home & HCB waiver care; slowing growth of a waiver for the disabled; cutting community support services & slashing basic medical care costs; raising some clients premiums; ending coverage of occupational & speech therapy & audiology; dropping adult dentistry & ending dental critical access pay-ments, dropping childless adults from MinnesotaCare; restricting state medical assistance to those below 75% FPL if they meet a medical incapacity qualifier rule; ending parents MinnesotaCare (theyd then have to seek Medicaid by meeting much lower TANF or medically needy income levels); and cutting Medicaid & MinnesotaCare parent asset levels. Almost all the eligibility cuts violate the stimulus bill & the legislatures budget bills (which would also cover 20,000 more children) would cancel them, but Pawlenty & GOP legislators still want deep cuts & he may veto the bills. Short of funds, Hennepin Cos Med. Ctr may end free care for other counties indigents & cut its mental health, dental & HIV services Mississippi---has no spend down; its risk pool has no low income premium discounts & no Medicare supplement. Gov. Barbour (R) cut the aged/disabled level from $1,000+ to $674/mo (the SSI rate). The parent level is 25%/46% if working (2008), CHIPs is 200% & ADAPs is 400%. Only 2 brand Rxs & 3 generics are allowed monthly (HIV patients get 5 brand Rxs & theres a suit against the limits). Barbour cut Rx fees & physical, speech & occu. therapy benefits. An in-person re-application rule retards enrollment. He & the Senate (D) wont drop it (except maybe for LTC clients), though the House (D) would. With a budget shortfall, Medicaid needs $268 million more in 2010. Barbour pledged not to cut it (yet is considering adding premiums & raising co-pays) and sought new cigarette & hospital taxes. A tobacco tax did pass, but the House still opposes the hospital tax & wants to use reserve funds instead to meet Medicaids $90 million shortfall. Missouri---a 209(b) state; its risk pool has no Medicare supplement but has a low income premium discount. Ex- Gov. Blunt & the legislature (both R) cut the aged/disabled level from 100% to 85%; ended state medical aid for those awaiting SSA disability awards; dropped the working disabled; cut the parent level to 20%/26% if working (2008); kept ADAP & CHIP levels of 300%; ended adult dental, podiatry, hearing aid & vision benefits; raised CHIP premiums; denied CHIP to those with job plans costing under 5% of income, unless they have preexisting condition limits or use up plan benefits); raised nursing home fees; restored wheelchair supplies coverage; and expanded the SPAP (its income level is 150%) to cover the disabled on Medicare. Blue Cross & a foundation subsidize insurance for KC-area families under $30,000. Blunts legislation authorized 2 pilot insurance subsidy plans for adults under 185%; raised & more strictly enforces non-ER co-pays; used premium support to merely pay clients job plan premiums rather than give them full secondary Medicaid; covered foster children until 21; raised MD fees to 62.5% of Medicare rates (Public Citizen said MO fees are the US 4th lowest); restored hospice & working disabled coverage (but only for those with very low SSDI checks); gave birth control & screenings to women under 185%; restored adult vision (except for the aged in nursing homes), hearing aid & podiatry coverage; and let the aged & disabled opt out of HMOs. A court made the state widen notice & hearing rights before CHIP terminations; and the state lets clinics enroll children. Gov. Nixon (D) asked the legislature (still R) to partially restore the parent level back up to 50% (which the House rejected); cover all adults dental, hearing & vision care; liberalize CHIP premiums & coverage (killed by a GOP-run legislative panel), and let over-income children buy into CHIP at cost. The deficit had already derailed his plans to raise the aged/disabled level back up to 100% Montana---has an aged/disabled level of only $674/mo (the SSI rate), a parent level of 35%/58% if working (2008) & an ADAP level of 330%.Its risk pool has low income premium discounts for those under 150% & a Medicare supplement. The state raised cost-sharing, cut LTC & hospice benefits & access and cut aged & disabled MD visits to 10 yearly. Gov. Schweitzer (D) & the legislature (R Sen; tied House) ended a CHIP waiting list (but ADAP now has a waiting list & other economies); seek a waiver to cover 3,000 more (maybe even non-disabled) adults; raised Medicaids family asset level; started a SPAP for Medicare patients under 200%; raised the CHIP level from 150 to 175%; widened CHIP dental & preventive care; made private plans offer vaccines & well-child care to age 7 & let children stay covered to age 25; and gave $2 million to community mental health centers. An 11/08 referendum authorized spending $20 million to raise the CHIP level further to 250% & liberalize child Medicaid, but a bill to allow CHIP coverage of contraception failed. Nebraska---is a Title XVI state with a one-house non-partisan, but conservative, legislature. Its aged/disabled level is 100%, its parent level is 46%/58% if working (2008), its CHIP level is 185% & its ADAP level is 200%. It dropped many welfare-to-work clients. The risk pool has a Medicare supplement but no low income premium discount. Gov. Heineman (R) covered Pt. D co-pays for HCB & board & care clients. Now with a budget deficit, hell limit dental care to $1,000/yr, hearing aids to 1 per 4/yrs, eyeglasses to 1 per 2/yrs, and adults to 12 chiropractic visits and 60 sessions of occupational, speech & physical therapy yearly. There are waiting lists for ADAP & for Ryan White Care Act-funded medical services. Nevada---a Title XVI state with no spend down & no risk pool; its disabled level is a mere $674/mo (the SSI rate); while the aged-only level is about $710.40 (their SSI/SSP rate); its parent level is 26%/91% if working (2008), its CHIP level is 200% & its ADAP level is 400%. It covers the working disabled; its SPAP (with a 225% income level) added coverage of all the disabled & now also offers vision benefits); rejected adopting Medicaid co-pays; but did raise CHIP premiums. A $2.8 billion deficit forced Gov. Gibbons (R) to ask the legislature (D-House; D Sen) to freeze CHIP enrollment (which a House panel rejected), cap CHIP dental care at $600/yr, end CHIP orthodontia & vision care, tighten nursing home, HCB waiver & at-home care medical qualification rules, reduce pregnant womens coverage, cancel a $17 million provider fee raise, cut hospital I/P fees 14%, & O/P rates 5% (causing closure of the U. Nev. at LV Hosp.s dialysis & oncology clinics, slash HCB care fees, drop Medicaid eyeglasses (also rejected by a House panel) & dentistry for adults; reduce personal care services for the disabled; cut I/P hospital neonatal rates 24% and pediatric heart, orthopedic, kidney, cancer & psychiatric specialist fees 41%; and make a later 10% cut in I/P hospital rates Gibbons proposes to get more Medicare, Medicaid & insurance payments for state mental health care and pledged to shield child coverage & the SPAP from cuts. The eligibility cuts will likely be voided by stimulus bill rules. The state mandate that counties pay almost all DSH & other hospital uncompensated care subsidies causes paltry & unfair hospital funding, leaving 5 major indigent-treating hospitals without any subsidies. Rising ADAP Rx costs forced the HIV agency to cut $1 million in LV-area client services New Hampshire---a 209(b) state with a risk pool with no Medicare supplement (but its considering adding a low income premium discount). Its aged/disabled level is about $687 (the SSI/SSP rate), its parent level is 41%/51% if working (2008), and the CHIP & ADAP levels are 300%. The state has a much-stricter-than-SSI 209(b) Medicaid disability rule (inability to work for 4+ years) & doesnt cover hospices. Gov. Lynch & the legislature (both D) shifted some state LTC costs to counties & ended a DD care waiting list. Lynch cut Medicaid $29 million (but wont cut low income clinic fees) & a House-passed budget (now in the Senate) makes millions in hospital & hospital-based MD fee cuts. The deficit is $75 million). The state made private plans let children stay covered to age 26 & may even let 19-to-26-yr-olds buy in to CHIP New Jersey---has no risk pool, an aged/disabled level of 100%; an ADAP level of 500%, and SPAP levels of $31,850 for 1 & $36,791 for 2.; A waiver covers others (even childless & non-disabled) under 100%. Gov. Corzine & the legislature (both D) required coverage of all children, made insurers let them stay on parent plans to age 31 & raised the parent level to 200%. Public Citizen said NJ provider fees were the US lowest, so the state raised many pediatric rates. One audit questions $52 million in school health costs & a 2nd said hospital indigency programs fail to collect millions from other liable payers. Some assisted living facilities wont let patients stay using Medicaid when their funds run out. Blue Cross sells a cheap CHIP-like policy to those over its 350% level With a $3.5 billion FY 2010 deficit, Corzine proposed cuts in hospital charity & teaching funding, ADAP co-pays of $6-$30 per Rx for those over 100% , $2 Medicaid Rx co-pays (but legislators are working to avert both co-pays), cutting the parent level to 150%, ending CHIP premiums for those under 200% & limiting the SPAP formulary (its co-pays were already raised); but raising MD fees & low income clinic funding New Mexicohas no spend down, but has a risk pool with a Medicare supplement & low income premium discounts for those under 200%. Its aged/disabled level is only $674/mo (the SSI rate), its parent level is 30%/69% if working (2008), its CHIP level is 235% & its ADAP level is 400%. A waiver has covered any adult (even if childless & non-disabled) under 200%, but its at full capacity & now has a waiting list. The state (even though federal funds to do so are available) wont make its own Medicaid-only eligibility/disability decisions for those who need medical care but are awaiting tardy SSA disability rulings. In 2007-08, Gov. Richardson (D) proposed raising the waiver level to 300 or 400% & widening access to it; giving Medicaid to all--even childless & non-disabled--adults under 200%; and a 300% CHIP level. But with a $500 million deficit, he & the legislature (D) dropped plans to enact those health expansions during the 2009 session New York---has no risk pool. A FamilyHealth waiver offers managed care (with no LTC benefits) to parents under 150% & childless (even non-disabled) single adults under 65 below 100% (150% for couples). But the childless aged level is only $725/mo & ADAPs is 431%. The state subsidizes insurance for workers under 250%, but caps its Rx benefits at $3,000/yr. The legislature (D House; now D Senate) excludes the disabled from the SPAP (with a 350%+ level); wont cover digital mammograms; raised Rx & MD co-pays (capping them at $200/yr); adopted a loose formulary; fosters assisted living, chore aide & adult day care; makes counties pay 1/2 of state Medicaid costs (but caps their cost increases at 3.5%/yr); lets providers deny services to those who dont meet co-pays; funded HIV day health care; covered colon & prostate cancer patients under 250%; covered the working disabled under 250%; required hospital bill discounts for those under 300% & banned taking homes from debtors; passed mental health parity; and raised CHIPs level from 250 to 400%. Public Citizen said MD fees were the US 2nd lowest, so the state is raising its fees to 70% of Medicares. Ex-Gov. Spitzer (D) started to let small firms that cant afford insurance buy into FamilyHealth at low rates. With a $15+ billion deficit, Gov. Paterson (D) signed a $1 billion+ hospital & nursing home fee cut; sponsors 30 to 60% Rx discounts for the disabled & those over 50 with incomes under $35,000; raised asset levels for all clients ($13,050 for 1, $19,200 for 2, etc); ended MSP asset tests; and seeks to cut HIV care $6 million and force NYC HIV & all dually eligible patients into HMOs. He proposed making private plans let children stay covered to age 29 and his budget raises the level for all adults to 200% (but only if it can be funded). Short $316 million, NYCs hospital system plans to cut child psychiatric & O/P Rx benefits and close some clinics; and NYC proposes to end its school-child dental program & cut HIV services $10 million North Carolina---has no risk pool; covers the working disabled; and covers only 8 Rxs a month (plus 3 or more on an exception basis).Its aged/disabled level is 100%; its parent level is 37%/51% if working (2008); and its CHIP level is 200%. The SPAP which excludes the disabledsubsidizes Pt. D premiums for those under 175% not on full Extra Help. The UNC Hosp. eased its indigent care rules, but asks for up-front cash co-pays. Provider fees are too low. The state had made counties pay 15% of Medicaid costs, but ex-Gov. Easley & the legislature (both D) shifted their share to the state as of 7/09. They raised the ADAP level to 300%, started a SPAP just for those ADAP clients on Medicare who are not eligible for Part Ds full Extra Help, passed limited mental health parity and started a risk pool which excludes Medicare patients & has no low income premium discount. With a $2 billion deficit, Gov. Perdue (D) proposed closing 50 state psychiatric hospital beds, saving $20.8 million with more generics use & getting higher rebates from drug manufacturers. A Senate (D) committee voted to freeze (already too-low) MD & hospital fees and cut the home care budget by 50%. North Dakota---this 209(b) state has a risk pool with a Medicare supplement but no low income premium discount. Its aged/disabled level is 100%, its parent level is 45%/62% if working (2008) & its ADAP level is 400%. A study by the GOP legislature urged a provider fee raise. Gov. Hoeven (R) signed bills to cover disabled children via the FOA (only up to 200%) & raise the CHIP level from 140 to 150% (but not yet in force as of 5/09), He then proposed boosting it again to 200% (which the House rejected), streamlining access to nursing homes, HCB waivers & home care; and raising MD fees Ohio--this 209(b) state with no risk pool cut the parent level from 100% to 90% & has a 500% ADAP level. It slashed adult dental funds 50%; cut secondary fees for dual eligibles; herded most patients into HMOs (some without enough specialists); slashed medical assistance for those awaiting SSA disability awards; let providers turn away those who dont meet co-pays; and passed mental health parity--but kept its aged/disabled level at $534/mo (the US very lowest !). Gov. Srtickland (D) & the legislature (R-Sen; D House) raised the CHIP level from 200 to 300% and covered disabled children under 500% via the FOA. Strickland got a waiver to cover assisted living & lets over income children buy into CHIP. He had to slash state funding of county eligibility work (but the House [D] now plans to restore $50 million of a $62 million cut, with Senate [R] passage less likely) & cut nursing home rates (which theyre challenging in court) and there are still wheelchair & medical supplies prior authorization backlogs. With a big deficit, the Governor delayed raising hospital, MD & DDS fees and fully restoring adult dental coverage; proposed $1.3 billion in fees on medical facilities & HMOs to fund Medicaid; and his health chief plans $80 million more in cuts (maybe even in Rx coverage). He proposed making private plans let children stay covered to age 29 & giving state mini-COBRA rights to small firms ex-workers Oklahoma---this 209(b) state has a risk pool with no Medicare supplement or low income premium discounts. It cut the aged/disabled level from 100% to about $720 (the SSI/SSP rate). The parent level is 32%/48% if working (2008) & ADAPs is 200%. It abolished its parents & children spend down, has a 3-Rxs/mo limit & doesnt cover hospices. Gov. Henry (D) covered the breast/cervical cancer & working disabled groups, and got a waiver to subsidize insurance for workers & spouses under 200% in participating small firms; employer eligibility was later widened & college pupils under 200% can now enroll. The legislature (R) made the insurance subsidy, more affordable & cheaper (but with barebones coverage exempt from the minimum benefits law); authorized Medicaid coverage of assisted living; streamlined enrollment red tape, raised the CHIP level from 185 to 300%; may make Medicaid a defined contribution plan; fosters employer plan & maybe even Medicaid HSAs; gutted the insurance minimum benefits law; and promotes primary & home care over ERs & nursing homes--but widened mental health coverage, raised MD & DDS fees & had even planned to raise nursing home fees in 2008. The deficit is $114 million & ADAP adopted cost-containment measures Oregon---this Title XVI states risk pool has no Medicare supplement but has low income premium discounts for those under 185%. Its income levels are $674/mo for the aged & disabled (the SSI rate), 100% for parents, 185% for CHIP & non-Medicare adults subsdized insurance and 200% for ADAP. An anti-tax referendum cut eligibility (except for HIV & transplant cases), limited adult dentistry & ended adult vision care. The OR Health Plan waiver--with limited benefits for non-Medicare childless & non-disabled adults under 100%--is again taking applications but enrolls only those who then win a lottery. The ADAP has some cost-sharing. Gov. Kungoloski & the legislature (both D) took the FOA option and he, legislative leaders & the states hospitals agreed to impose a new hospital tax to fund coverage for 60,000 more adults. Pennsylvania---has no risk pool, an aged/disabled level of 100%, a parent level of 27%/36% if working (2008), a CHIP level of 300% & an ADAP level of 350%. It subsidizes AdultBasic insurance (with no mental health or Rx benefits & a waiting list of 118,000+) for non-Medicare adults under 200%, With income levels of $23,500 for 1 & $31,500 for 2, the SPAP excludes the disabled. Gov. Rendell (D) covered the working disabled & sought to return HMO Rx benefits to state control to get $95 million in drug rebates. The House (D) voted to open AdultBasic to many more patients and add Rx & mental health benefits to it. Senate (R) leaders oppose this, spurned several compromises offers by Rendell & then even increased their Senate majority by one in 11/08. He then proposed doubling AdultBasic enrollment, later said hell enroll 16,000 more waiting list patients in it & again sought to add an Rx benefit to it and will sign a bill making private plans let children stay covered to age 29. But he called for cutting hospital rates $75 million (to which the Senate responded with a $116-$280 million cut) & Public Citizen says PA MD fees are the US 5th lowest. The state deficit is $2.3 billion; a shortfall may force Philadelphias free city clinics to adopt sliding scale fees for care & Rxs and close some branches; and its Northeastern Hosp. (with its patients on low-paying Medicaid, helping cause a $15 million deficit) is closing. Puerto Rico----its matching rate is capped below what states get. It claims theres no ADAP waiting list (its income level is 200%). ADAP reviews & audits report inadequacies in care, unaccountability, mis-management & fiscal irregularities Rhode Island---has no risk pool, an aged/disabled level of 100%, a parent level recently cut from 185% to 175%, a CHIP level of 250% & an ADAP level of 400%. It covers the working disabled and its limited formulary SPAP covers the aged but only those disabled over age 55 (its income levels are $37,167 for 1 & $42,476 for 2). Gov. Carcieri (R) signed bills to subsidize insurance for low-paid small firm workers; gut the insurance mandated benefits law); require free & discounted hospital care for those under 200% & 300%;and ban taking homes from hospital debtors. Public Citizen says MD fees are the US 3rd lowest. Big deficits ($660 million in FY10) moved him to get a CMS waiver with extra up-front federal funds that in exchange requires the state has to divert 12% of nursing home cases to cheaper home care & accept a cap on future federal funds that could deny LTC to all but highest need clients & raise premiums. The legislature (D) raised adult daycare co-pays; dropped legal alien children & 7,400 adults and reluctantly approved the waiver (which it will closely monitor). See  HYPERLINK "http://www.povertyinstitute.org" www.povertyinstitute.org & RIs Medicaid Proposal. at  HYPERLINK "http://www.cbpp.org" www.cbpp.org; and email  HYPERLINK "mailto:lkatz@ric.edu" lkatz@ric.edu for a critique & details. The Medicaid chief said more cuts (e.g., dropping eyeglass benefits & 40,000 more clients) may come. Carcieri proposed abolishing the SPAP for those over 65; ending parents dental care; and cutting nursing home fees 5%. South Carolina---has no spend down. Its aged/disabled level is 100%, its parent level is 49%/90% if working (2008) & its ADAP level is 300%. Its risk pool has a Medicare supplement but no low income premium discount. Gov. Sanford & the legislature (both R) limited Rxs to 4/mo; are moving patients into HMOs (yet allowing opt-outs); but raised the CHIP level to 200%. The SPAP has a 200% level but excludes the disabled. Theres a $250+ million deficit. The legislature cut mental health care; closed an HIV program to new clients; cut home health, hospital & LTC funds but wont drop cancer screenings & treatment or hospice care but did cut SPAP benefits deeply, although by less than Sanford wanted. It will revoke CHIP & Medicaid eligibilitybut maybe not all benefit-- cuts, as the stimulus bill requires. Sanford proposed to restore $137 million in health funds & foster cheap, barebones insurance. He relented on refusing some but not all stimulus funds---but his GOP Senate allies want to divert $400 million in US Medicaid stimulus funds to public schools. The House passed a new 50 cent tobacco tax to fund insurance subsidies for those under 200% & those in firms of under 25; GOP Senators oppose that, while Senate Democrats would prefer to spend any new funds on strengthening Medicaid South Dakota---has no spend down & a risk pool with no low income premium discount that excludes Medicare patients. Its aged/disabled level is $674/mo (the SSI rate), its parent level (working or not) is 54% (2008) & ADAPs is 300%. A health study panel suggested some coverage expansions to Gov. Rounds & the legislature (both R), but he wont raise the pregnant woman level to 200% or CHIPs 200% level to 250%. They cut $2 million+ from a program that treats infant & toddler developmental problems (which had to be reversed to meet the stimulus bills maintenance of effort mandate), but still plan to drop a planned provider fee increase and end adult dental coverage. The 2010 state deficit will be $81 million. Tennessee----Gov. Bredeson (D) & the legislature (R) dropped 191,000 adults, but no children. The aged/disabled level is $674/mo (the SSI rate), the parent level is 73%/134% if working (2008) & the ADAP level is 300%. Except for pregnant women, children & HIV+ patients, MD visits were cut to 10; hospital days to 20 yearly; and Rxs to 2 brand drugs/mo + 3 generics/mo except for certain serious conditions. The state raised CHIPs level to 250%; has a risk pool (with no Medicare supplement, but with a premium discount for those below 200%), has a SPAP (with a waiting list) covering up to 5 Rxs (generics only) monthly for non-Medicare clients under 250%; and subsidizes insurance for those under $55,000. Except for also covering diabetic Rxs & supplies & more psychiatric Rxs, CHIP uses Medicaids Rx rules. The spend down was restored, but Bredeson cut its budget (plus those for home care & medical equipment) and didnt fund safety net benefits hed promised the disabled who lost Tenncare. The deficit may be $1.25 billion & require $400 million more in cuts (even though theres $400 million in a state reserve fund). Bredeson got a US court to dissolve a 1987 order grandfathering-in 150,000 ex-SSI recipients (most now ineligible for Medicaid under regular rules) & has begun plans to review such cases & terminate those not eligible under todays normal rules; see the Daniels Case fact sheet at  HYPERLINK "http://www.tnjustice.org" www.tnjustice.org The Mayor proposed a 10% cut in Nashvilles city subsidy to its safety net General Hospital. Texashas a risk pool with a Medicare supplement & but no low income premium discount. The aged/disabled level is $674/mo (the SSI rate), the parent level is 13%/27% if working (2008) & the ADAP & CHIP levels are 200%. Gov. Perry & the legislature (both R) dropped coverage of CHIP prostheses, physical therapy & private duty nursing; raised CHIP co-pays & premiums; cut Medicaid home health; ended adult chiropractic & podiatry care; capped Medicaid Rxs allowed monthly; moved patients into HMOs (but, after many quality of care questions, cancelled one big HMO contract for the aged & disabled); began contracting-out eligibility determinations (with many complaints) and restored Medicaid mental health, vision & hearing aid coverage and CHIP mental health & dentistry (limited adult dentistry is covered, but dentures & multiple extractions need pre-authorization); mandated some mental health parity in private plans; started a SPAP just for HIV clients; and seeks a waiver to insure parents under 133%, childless, non-disabled, non-aged adults below 100% & maybe later even all non-Medicare adults under 200%. See  HYPERLINK "http://www.hhs.state.tx.us/Medicaid/Reform.shtml" http://www.hhs.state.tx.us/Medicaid/Reform.shtml .A court order to improve childrens care will require MD & DDS fee raises (but adult rates remain too low). The Senate voted for a pilot program as one step toward conditioning MD & hospital fee on case outcomes. The House voted to cover disabled children under 400% via the FOA & apparently killed a bill raising the CHIP level to 300%; but its decision on a measure restoring Medicaids adult spend down is unclear. Caseload growth is causing a $1 billion rise in CHIP & Medicaid costs Utaha Title XVI state with a risk pool--with a low income premium discount, but no Medicare supplement. Its aged/ disabled level is 100%, its parent level is 48%/68% if working (2008), CHIPs is 200% & ADAPs is 400%. A waiver gives limited O/P care, with big co-pays, to non-Medicare adults (even if childless or non-disabled) under 150%. The legislature (R) ended coverage of podiatry; audiology & speech therapy; chiropractic care; outdoor wheelchairs; and adult eyeglasses; but restored adult dentistry (only for the aged & disabled & only for 1 year), yet may still cut CHIP dentistry (the spend down, pregnant womens & family coverage cuts once proposed were abandoned). Outgoing Gov. Huntsman (R) started subsidizing premiums of some small firm workers under 200% (the legislature has since considered giving subsidies to even more workers & children; See New CHIP/UPP Waiver..Paper at  HYPERLINK "http://www.healthpolicyproject.org" www.healthpolicyproject.org) & set up an insurance reform board that may suggest community rating, banning pre-existing condition exclusions, cheaper policies with no costly benefits mandates & malpractice reform A 2nd legislative health panel would gut the minimum benefits law; ban pre-existing condition rules; get insurers to offer small firms & the unemployed barebones, cheaper-than-COBRA policies (this was enacted); and urge employers to give workers HSAs instead of regular insurance. The deficit is $272 million. Incoming Gov. Herberts (R) health policy record has followed the legislatures and Huntsmans Vermonthas an aged/disabled level of 125% & a parent level of 185%. The CHIP level is 300%, ADAPs is 200% & the SPAPs is 175%. The state subsidizes health insurance for others under 300%. The legislature (D) reversed most of Gov. Douglas (R) adult dental cuts (but dentures still arent covered & theres a $495/ yr cap). A waiver, in return for more funds, puts patients into HMOs & favors HCB care over nursing homes--but caps future federal matching funds. Theres no risk pool. Theres a $100+ million shortfall for FY 2010. Douglas pledged to not cut eligibility, but increased some SPAP co-pays and seeks more cost-sharing for richer Medicaid & CHIP patients and an Rx dispensing fee cut. Virginia---a 209(b) state with no risk pool. Its aged/disabled level is 80%, its parent level is 24%/30% if working (2008), the CHIP level is 200% & ADAPs is 300%. Gov. Kaine (D) covered the working disabled & started a SPAP for HIV+ Medicare patients under 300%, but dropped plans for 100% parent & 300% CHIP levels & subsidized insurance for those under 200% The legislature (D-Sen; R-House) killed Kaines pilot subsidized insurance plan for those under 200%, but he got a foundation to fund it. With a $2.9 billion deficit, he cut health & welfare administrative costs $87 million; de-funded a small indigent health program; and sought a $400 million Medicaid cut, mostly in hospital & nursing home rates. But the legislature restored millions for hospital & nursing home fees; found $7.5 million to fund 400 more HCB waiver slots for the mentally disabled; but voted to drop mandated benefits minimums for certain small firm employee groups. Virgin Islands--its matching rate is far below what states get. Some say its ADAP (with a 400% level) has a waiting list. Washington--its risk pool has a Medicare supplement & a low income premium discount for those under 300%. Its aged/disabled level is about $720 (the SSI/SSP rate), its parent level is 38%/77% if working (2008) & ADAPs is 300%. Gov. Gregoire & the legislature (both D) covered Pt. D Extra Help co-pays; passed mental health parity; and made private plans let children stay covered to age 25. Facilities evicted 75+ assisted living clients due to low state fees. A $9 billion deficit wont allow the state to raise CHIPs level from 250 to 300%. The state proposed removing 40,000 patients from BasicCare (state-subsidized insurance for non-Medicare adults under 200%); slashing Gen. Asst. medical aid $190 million (dropping 3,000 more), hospital DSH payments $107 million, & nursing home rates $38 million, cutting druggist (after a court barred a $25 million cut, the state proposed a mere $12 million cut), pediatric, HMO & adult day health center fees (the last by 70%) and may drop adult dentistry & colorectal cancer screening. Legislators are considering bills for a referendum to raise the sales tax by $381 million to avert Medicaid & health cuts & boost low income clinic subsidies; to streamline CHIP eligibility; and to let over-income children buy a watered-down CHIP plan with unsubsidized premiums West Virginia---has an aged/disabled level of $674/mo (the SSI rate), a parent level of 17%/34% if working (2008) & an ADAP level of 250%. It covers only 4 brand Rxs/mo (+6 generics). Its risk pool has no Medicare supplement or low income premium discount (but is considering one). It cut medical equipment & transport funds; denies adult dental care; and didnt properly adopt nursing home & HCB medical admission rules (which still limit HCB access). Gov. Manchin & the legislature (both D) sponsor an Rx plan for non-Medicare adults under 200%; and give clients more mental health care & Rxs to sign personal responsibility contracts. See Mountain Health Choices reports at  HYPERLINK "http://www.familiesusa.org" www.familiesusa.org &  HYPERLINK "http://www.hsc.wvu.edu/wvhealthpolicy" www.hsc.wvu.edu/wvhealthpolicy .The state raised the CHIP level to 250% (and is even considering going up 300%) & plans to raise child dental fees (but adults still get extractions only). Manchin vetoed a bill raising some private (but not any public) mental health provider fees. Instead, hell use $12.7 million in regular Medicaid & stimulus funds for community mental health care & to reduce state mental hospital overcrowding. He has been---and (despite no action so far) says hes still-- considering calls (see Shot in the Arm at  HYPERLINK "http://www.familiesusa.org" www.familiesusa.org ) to raise the parent level, first to 50% & maybe later to 100% (and possibly even cover all childless adults too); but some advocates doubt this will happen Wisconsin---has an aged/disabled level of only about $757.78/mo (the SSI/SSP rate), a 200% parent level & a 300% ADAP level. The SPAP (with a 240% level) excludes the disabled. The risk pool has a Medicare supplement & premium discounts for those under $25,000. Gov. Doyle (D) got the Senate (D) & House (then R) to raise the CHIP (185 to 300%) & parent (185 to 200%) levels (but not the aged & disabled levels), make private plans cover child hearing aids & cochlear implants and offer basic care (with physicals & generics--but not brand name Rxs, home health care or most medical equipment) to non-Medicare childless (even non-disabled) adults under 200%. The deficit is $700 million. Doyle proposed a hospital tax to generate $900 million more to raise hospital fees & may seek a House (now D) vote on the Senate (D)-passed Healthy WI universal coverage plan. Medicaid, CHIP & contract HMO dental fees are too low and CMS & a state audit said the resulting lack of providers in turn reduces access to dental care----especially for children Wyoming---has no spend down; an aged/disabled level of about $699 (the SSI/SSP rate), a parent level of 40%/54% if working (2008), a CHIP level of 200% & an ADAP level of 332%. Its SPAP covers non-Medicare patients under 100%. The legislature (R) added CHIP mental health, vision & dental care; and was even considering raising MD fees. Gov. Freudenthal (D) added a low income premium discount for those under 250% to the risk pool (which also has a Medicare supplement) and proposed developing a cheap, pilot, yet barebones, state-sponsored health insurance for the uninsured. SOURCES AND RESOURCES: For the 48 states & DC, 100% of the 2009 federal poverty level (FPL) is $10,830 yearly ($902.50/ mo) for one plus $3740 yearly ($311.67/mo) more for each addl person; see the Assist. Sec for Plan. & Eval. pages at  HYPERLINK "http://www.dhhs.gov" www.dhhs.gov for AK & HI. In 2008, 100% of the FPL was $10,400/yr ( $866.67/ mo) for one & $3,600/yr ($300/mo) more for each addl person .The 2009 SSI rates (not including state supplementary payments, or SSPs) are $674/mo for 1 person & $1.011 for 2. Email  HYPERLINK "mailto:sheryy.barber@ssa.gov" sherry.barber@ssa.gov for State Asst. Programs for SSI Recips, 1/08(the latest compilation) on state Medicaid rules for SSI recipients, state supplement (SSP) amounts & state Section 1616, 1634 & 209(b) arrangements See  HYPERLINK "http://www.familiesusa.org" www.familiesusa.org for Est. New Federal Fundingfor Medicaid by State, 2008-11 in the American Recovery & Reinvestment (stimulus) Act, including its enhanced matching rates & state maintenance of effort mandates--for which CMS guidelines are summarized under whats new at  HYPERLINK "http://www.healthlaw.org" www.healthlaw.org . Also see Health Care & Medicaid: Weathering the Recession at  HYPERLINK "http://www.kff.org" www.kff.org on grave funding challenges states still face in maintaining & extending coverage. See Building..Medicaids Role in a Reformed Health..System at  HYPERLINK "http://ccf.georgetown.edu" http://ccf.georgetown.edu , Improving Medicaid As Part of Building on the Current System to Achieve Universal Coverage at  HYPERLINK "http://www.cbpp.org " www.cbpp.org and Covering Low Income & High-Need Americans: Medicaid as a Platform forReform, Coverage & Cost Impacts of Expanding Medicaid, Expanding.. Coverage for..Adults: Filling Gaps in Medicaid Eligibility at  HYPERLINK "http://www.kff.org" www.kff.org and Making Parents Health Care a Priority at  HYPERLINK "http://www.nccp.org" www.nccp.org (again noting that wider parent coverage promotes child coverage). Up to $75 million in state health expansion grants is available: see the State Health Access pages at  HYPERLINK "http://www.hrsa.gov" www.hrsa.gov Medicaid Benefits8/07 at  HYPERLINK "http://www.kff.org" www.kff.org shows states chiropractor, podiatry, eyeglasses, optometry, hearing aid, hospice, psychologist, prosthetics, home health, medical equip, Rx.& OTC drugs and physical, occupational & speech therapy coverage in 2003-6; see Adult Benefit Chart at  HYPERLINK "http://www.medica9iddental.org" http://www.medicaiddental.org for adult dental coverage See guides on blocking bad state plan amendments at  HYPERLINK "http://www.healthlaw.org" www.healthlaw.org. To ensure that plan changes/waivers get approved by legislatures & not just Governors & state agencies, see  HYPERLINK "http://www.nachc.com/advocacy/Files/state-policy/model520state520legislationh.pdf" http://www.nachc.com/advocacy/Files/state-policy/model520state520legislationh.pdf &  HYPERLINK "http://www.nachc.com/advocacy/Files/ModelStateLegislation-AppropriationsRiderssr031406_RS-.pdf" http://www.nachc.com/advocacy/Files/ModelStateLegislation-AppropriationsRiderssr031406_RS-.pdf; and a state health reform/expansion guide at  HYPERLINK "http://www.communitycatalyst.org" www.communitycatalyst.org . The National ADAP Monitoring Report, 2009 at  HYPERLINK "http://www.kff.org" www.kff.org , lists state income & asset levels in Table XIX and their policies to coordinate with Part D in Table XXVI. The Report also covers state cost sharing rules & medical criteria and/or prior authorization for special or costly drugs. State formularies are listed in a 2nd adjacent document. See The AIDS Drug Assist Program.. at  HYPERLINK "http://www.theaidsinstitute.org" www.theaidsinstitute.org for state program analyses & reform suggestions & ADAP Watch at www.NASTAD.org for news of state waiting lists, cost containment measures & state websites State Rx co-pay data is in State Medicaid Drug Reimburse. at  HYPERLINK "http://www.ascp.com" www.ascp.com . See Pharm. Benefits [in] State [Medicaid] at  HYPERLINK "http://www.npcnow.org" www.npcnow.org on formularies, fees, OTC coverage, prior auth., prescrib/dispensing limits & co-pays. Medicaid Prescription Drug Policies.. in Psychiatric Services (5/09) at  HYPERLINK "http://psychservices.psychonline.org" http://psychservices.psychonline.org finds that state access limitations on psychiatric Rxs cause 3.6 times more hospitalization, homelessness, suicides & jailings. See Grading the States, 2009on their public mental health systems quality under press releases at  HYPERLINK "http://www.NAMI.org" www.NAMI.org A Medicaid to Medicare Fee Index in Medicaid & CHIP at 50 State Comparison in  HYPERLINK "http://www.statehealthfacts.org" www.statehealthfacts.org lists state Medicaid MD fees compared to Medicares, showing most having risen since 2003yet still not equaling it. See  HYPERLINK "http://www.ncsl.org/programs/health/SPAPCoordination.htm" http://www.ncsl.org/programs/health/SPAPCoordination.htm ,  HYPERLINK "http://www.medicare.gov/spap.asp" http://www.medicare.gov/spap.asp & The Role of..[SPAPs In]...Pt D (7/07) at  HYPERLINK "http://www.kff.org" www.kff.org . Email  HYPERLINK "mailto:jcoburn@hdadvocates.org" jcoburn@hdadvocates.org for chart on how drug makers Patient Assist. Programs (PAPs) mesh with Pt D. The 6 drug classes excluded by Pt D can be covered by Medicaid; such state coverage is charted at  HYPERLINK "http://www.medicareadvocacy.org/Part D_ExcludedDrugsbyState.htm" www.medicareadvocacy.org/Part D_ExcludedDrugsbyState.htm (12/1/05 report at News icon) See IndividualModels of LTC at  HYPERLINK "http://www.statehealthfacts.org" www.statehealthfacts.org for state coverage of HCB waivers, home health, personal aides & related care & Money Follows the Person 101 at  HYPERLINK "http://www.nsclc.org" www.nsclc.org. Email  HYPERLINK "mailto:lsmetanka@nccnhr.org" lsmetanka@nccnhr.org for 2006 state personal needs allowances (PNAs) for SNF & ICF patients and those in SSP-funded board & care homes. See  HYPERLINK "http://www.naschip.org" www.naschip.org on state risk pools & to order Comprehensive Health Ins. for High Risk Individuals: A State-by-State Analysis...[2008] on funding, eligibility, benefits, Medicare supplements, premiums & low income discounts. See From CANN in Other Organizations Materials under Library at  HYPERLINK "http://www.healthlaw.org" www.healthlaw.org for Painless Ways To Deal With..Medicaid Budget Shortfalls to avoid eligibility & benefits cuts; State..Aged/Disabled ... Income Levels & StateParent..Income Levels; a health/Medicaid Glossary; and 2009 VA HealthBenefits     PAGE  PAGE 13 The Ryan White CARE Act, Title II, Community AIDS National Network, Inc.  Thomas P. McCormack Editor, MEDICAID WATCH MedicaidWatch is supported by unrestricted educational grants from GlaxoSmithKlien, Abbott Laboratories, Amgen, Gilead Sciences, Merck & Co., Bristol Myers Squibb, Boehringer Ingelheim & Tibotec Therpeutics 1773 T Street, NW Washington, DC 20009 Chief Executive Officer: William E. Arnold Phone: (202) 588-1775 Fax: (202) 588-8868 Web: www.tiicann.org Email:  HYPERLINK "mailto:weaids@tiicann.org" weaids@tiicann.org Board of Directors Jeff Bloom Eric Camp Donna Christensen MD MOC Jeff Coudriet Wayne A. 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