Fri, Aug 12, 2016 at 07:30 PM

Medicaid cuts will affect each of us - funding is essential

When state lawmakers begin a special session on Monday, August 15 to find additional revenue for Alabama coffers, the most pressing need they face is funding Medicaid, according to experts in state and local healthcare systems.

Marshall Medical Centers' CEO, Gary Gore, lists many problems he expects as a result of a failure to fund the Medicaid system. First, it will reduce payments for specialties that treat a disproportionate share of Medicaid patients, such as pediatrics, obstetrics and family medicine. Those doctors could decide to leave communities in Alabama for more lucrative areas, he predicts.

"This will impact access and quality for all patients, not just Medicaid patients," Gore says. "This is my main, short-term concern."

More local impact includes:

• Approximately 11% of the services provided at Marshall Medical Centers are provided to patients with Medicaid as their primary coverage.  
• Medicaid reimbursement rates are significantly less than cost and what commercial insurance typically reimburses. While payments are generally poor, they represent a significant source of funding for Marshall Medical and its community. 
• Alabama's Medicaid benefit program is already bare bones and generally only provides benefits for what is mandated by federal law. 
• Due to mandated minimums and the complex federal matching program, there are only a few areas in which Medicaid can cut expenses. Some of these include reducing payments for physicians and eliminating coverage for eyeglasses, prescription drugs, outpatient dialysis and home care. 
• After cuts are made to such services as those for home health and children, those patients likely will go to emergency rooms for care.  That is a very costly result that will create delays and other problems, ultimately increasing costs.
• Approximately 10 percent of services provided by Marshall Medical Centers go to those who are uninsured. Many of those - mostly the working poor - would be covered by Medicaid if it were expanded as allowed under the Affordable Care Act. Marshall County has an uninsured rate of approximately 22 percent, which is higher than the state average at 16 percent.  With the unemployment rate around 5%, Marshall County has a disproportionate share of employed people who do not have health insurance.
• The economic impact of expanding Medicaid would be significant for Marshall County. Over 90% of funding would come from the federal government. Taxpayers in Alabama have paid for Medicaid expansion in the majority of states for three years without receiving any of the health and economic benefits in return. As a poor state, Alabama would benefit more than most states that have expanded Medicaid.

As the largest consumer of dollars from the state general fund, the Alabama Medicaid Agency serves about one million Alabamians. It provides health coverage for eligible children, pregnant and severely disabled and impoverished adults. Medicaid pays for more than half of all births in the state, as well as covering 47 percent of all children and 60 percent of nursing home residents.

Earlier this year, lawmakers overrode Gov. Robert Bentley's veto and approved a budget that appropriated $700 million from the general fund for Medicaid for next year. That amount fell short by $85 million, according to Bentley, who says Medicaid needs $785 million to maintain services.

On August 1, Alabama began applying cuts to the state's Medicaid system that will affect all Alabamians, not just Medicaid recipients.

The Alabama Hospital Association is urging state residents to contact their local representatives to encourage them to find a long term, sustainable solution to fund Medicaid. Gore and AHA stop short of endorsing a lottery to provide that revenue, but agree that all measures should be considered when it comes to funding Medicaid adequately.