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Medicaid recipients wait for budget ax to fall

Looming budget cuts have health providers and patients worried

By Lisa Ryckman, Rocky Mountain News (Contact), Ed Sealover, Rocky Mountain News

Published February 2, 2009 at 12:05 a.m.

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Anna Borquez, 58, is a diabetic with other medical issues. She is worried that the Medicaid she depends on may be cut.

Photo by Dennis Schroeder / The Rocky

Anna Borquez, 58, is a diabetic with other medical issues. She is worried that the Medicaid she depends on may be cut.

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Anna Borquez owes her life to Medicaid.

Diabetic and disabled by a neurological disease, the 58-year-old Lakewood woman relies on the state-run health insurance for access to her caring doctors at Clinica Family Health Services and the six medications she needs each day.

"I thank God I do have it. If I didn't have Medicaid, I'd be dead," Borquez said.

At Clinica, the staff handles 150,000 visits per year, most from working people whose jobs still leave them at or below 200 percent of the federal poverty level, or about $41,000 for a family of four.

It's a difficult situation, and it might get a lot tougher.

Faced with a $1 billion budget deficit, Gov. Bill Ritter has proposed cuts across state government, including slashing $223 million from the Department of Health Care and Policy Financing. If approved, Medicaid expenditures, provider rates and reimbursement obligations, among other things, would be reduced.

People who serve low-income clients are trying to determine the impact of Ritter's proposals. On the plus side, any cuts ultimately could be offset by the federal stimulus package or a proposed state hospital fee. But they say it's also clear that people who have the least would suffer the most under cuts to government-funded health care.

Many advocates are resigned to the idea that the cuts must be made, but some legislators aren't ready to give in.

"I intend to fight all of it," said Democratic state Rep. Anne McGihon of Denver, a member of the House Health and Human Services Committee. "These are the poorest of the poor who are being affected."

About 11,000 low-income patients would lose access to care as a result of cuts in Medicaid funds to community health centers, said Polly Anderson, policy director for the Colorado Community Health Network, which includes Clinica, and serves about one-third of the state's Medicaid clients.

The Community Health Network's 15 nonprofit or public health centers operate 120 community, migrant, school-based and homeless clinics that treat 401,000 people per year, Anderson said.

The centers report that visits this fall were up by as much as 40 percent over the same time a year ago, Anderson said.

"More troubling is that there are health centers that don't have the capacity to add even one more patient, so the waiting lists for medical, mental health and dental care have been growing," she said.

Ritter also has proposed a moratorium on increasing the threshold for the state's Child Health Plan Plus (CHP+)to 225 percent of poverty, which would have covered 50,000 more children. Nearly 100,000 of Colorado's 170,000 uninsured children are eligible for coverage but aren't enrolled, said Stacey Moody, project director of Covering Kids and Families, a statewide coalition that works to enroll uninsured families in the right program.

In the past year, the state insured an additional 35,000 eligible children, a 13 percent increase in enrollment, Moody said. Outreach programs designed to find and sign up eligible families would lose a chunk of funding under the proposed cuts.

Private doctors who treat Medicaid patients also would see a drop in reimbursement, which advocates predict might drive more caregivers out of the program. Right now, 30 percent of the state's family medicine doctors and 13 percent of pediatricians don't accept Medicaid patients, said Joan Henneberry, executive director of the Department of Health Care Policy and Financing.

The problem is exacerbated in rural areas, where the loss of even one doctor who accepts Medicaid could leave people over a vast area with no access to medical care.

Ritter had worked to increase Medicaid reimbursement rates after a Blue Ribbon Commission on Health Care Reform pinpointed it as key to increasing access and saving money.

Low-income residents without a primary doctor often wait to get help until they are very sick and then go straight to the emergency room, needing serious attention for something that could have been treated more easily - and more economically - if caught earlier.

For Borquez, that reality hit home when her brother died of cancer last year. He had no insurance and had resisted applying for Medicaid, which meant his disease was in the final stages when it was diagnosed.

By the time her brother got Medicaid, Borquez said, it was too late.

"The only thing it paid for," she said, "was the ambulance that took him to the hospital to die."

Possible routes around Medicaid cuts

* The federal stimulus package includes a change in reimbursement to the states: Instead of matching every 50 cents spent, the feds would pay 55 cents for every 45 cents the state spends on Medicaid, which would provide a new influx of cash to maintain and expand programs.

* A state legislative measure would charge per-patient fees to hospitals and then leverage the $600 million expected annual revenue to get a federal match. The $1.2 billion would be used to increase Medicaid and CHP+ eligibility levels and add another 200,000 people, Colorado Hospital Association President Steven Summer said.

Comments

  • February 2, 2009

    12:24 p.m.

    Suggest removal

    T1anda writes:

    Everyone is being set-up. Soon Obama the great, will unveil his "health plan"and everyone will be on a Medicade/Medicare type program.

    Don't fret Anna Borquez Obama to the rescue! He will save us all!