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Medicaid proposes cuts in five areas

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By NANCY HICKS / Lincoln Journal Star

Sunday, Jan 27, 2008 - 07:50:27 pm CST

State Health and Human Services leaders would like to reduce five services provided by Medicaid — from chiropractic visits to dental care — for an estimated $2.54 million in cuts from the $1.5 billion health care program.

Several groups representing poor Nebraskans and people with disabilities have already begun objecting to the proposed cuts, outlined in an early January letter to state leaders, hoping that senators will halt some of them.

“Obviously we have some serious concerns about this,” said Jennifer Carter, director of a healthcare access program with the Nebraska Appleseed Center for Law in the Public Interest.

Story Photo
Proposed Medicaid cuts

* Reduce dental services from unlimited coverage to $1,000 a year, with “$1.46 million annual savings.

* Reduce new eyeglasses from one pair every year to one every two years, with annual savings of $115,500.

* Reduce chiropractic visits from 20 per year to 12, with annual savings of $69,000.

* Reduce hearing aids from unlimited to one every four years, annual savings of $90,000.

* Reduce outpatient medical rehabilitation for adults from no visit limit to 60 visits per year, annual savings of $807,000.



“We are particularly concerned because the Medicaid population tends to be very, very poor. And they don’t have the disposable income to make up for whatever holes there might be in their coverage,” Carter said.

Medicaid officials outlined the cuts in an early January letter to state leaders. Medicaid, a federal and state funded program, served about 201,000 people last year, primarily low-income elderly, low-income families and people with disabilities.

The cuts are modeled after state employee health care coverage, according to the letter.

At least two senators have responded with legislation relating to the cuts.

Sen. Joel Johnson, chairman of the Legislature’s Health and Human Services Committee, said he has concerns about the dental coverage limit. People who don’t get dental care for some conditions, like an abscessed tooth, can end up in the emergency room with “very expensive complications,” he said.

Johnson introduced a bill (LB1122) this week that would make dental coverage mandatory so the state agency could not reduce the benefits. Senators are looking at the cuts to make sure money will be saved and it “won’t end up costing more money in the long run,” Johnson said.

The proposed cuts will have “a real negative impact on the disabled community,” said Kathy Hoell, executive director of the statewide Independent Living Council.

People with disabilities are particularly concerned about the cut in rehabilitation services, she said. “When I had my brain injury, I had speech therapy, occupational and physical therapy every day for a year. I wouldn’t be doing the things I’m doing now if I hadn’t had that therapy,” she said.

Other states have made an exception for people with disabilities from any limitation on rehabilitation services, said Eric Evans, with Nebraska Advocacy Services.

Some psychotropic drugs for people with serious mental illness cause dental decay, and older psychotropic drugs have caused diabetes, with its potential for vision problems, Hoell said. Now the state wants to limit coverage for those conditions.

The letter also raises a number of questions, Hoell said. If a person needs hearing aids for both ears, does the four-year limit mean he or she can’t get a full set of hearing aids for eight years.

Advocates for low-income and disabled Nebraskans are also concerned about the notification system for the cuts.

Under current law the legislature can stop the change by taking action during the legislative session, Johnson said.

But HHS waited until the last minute — one day before senators began the 2008 Legislative session — to send the letter, Carter pointed out. That Jan. 8 letter did not give an advisory council time to react and gave senators very little time to act, she said.

Sen. Annette Dubas of Fullerton would correct what Carter called ” a flaw in the current system,” by requiring HHS to send the report on future Medicaid cuts to state leaders at least 60 days before a Legislative session begins.

Dubas’ bill (LB1176) also has language putting all the cuts suggested by HHS into law. The measure is not a statement about what Dubas believes is the right thing to do. It is a vehicle to assure public discussion, the senator said.

A public hearing is required for every bill, thus giving people a chance to comment on the cuts, she said. The bill could be amended later to prohibit some of the cuts, but without a bill there would be no chance for people to provide input, Dubas said.

Reach Nancy Hicks at 473-7250 or nhicks@journalstar.com.


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whatever wrote on January 28, 2008 5:11 am:
" These seem like very modest cuts for a program where the spending is at an obscenely high level. "

 BYOB wrote on January 28, 2008 7:05 am:
" Finally- - -Dr.Johnson found something to be right about,
just when I thought there was no hope for this man, he pulled it out.
My mother died from bad teeth and dental infection. "

 Hank wrote on January 28, 2008 7:44 am:
" By all means, let's cut needed medical assistance to people who are very poor while we are about to send large checks to high income people who don't need more money just to "stimulate the economy." This really shows what kind of country we have become. "

 sss21 wrote on January 28, 2008 8:50 am:
" People that pay for their health care have limits they have to follow, even if they do not have "disposable income". Why should it be any different for Medicaid recipients? "

 AJ wrote on January 28, 2008 9:06 am:
" Once again the government is cutting benefits to the "very" poor! These folks need all the help they can get to get out of the "poor rut". And what about the innocent children? If they don't have regular dental checkups and care, then their teeth and overall health will suffer and the eventual costs will be much more than the annual dental visit. Why doesn't this USA care for its poor? Why is it when money needs to be saved it's taken out on the poor and not the wealthy? There is truth in the old saying, "the rich get richer and the poor get poorer." "

 Dee wrote on January 28, 2008 9:12 am:
" Why dont we cut some of the corporate welfare programs we have Medicaid is a block grant program and requrires matching or contributing funds from the state. Why dont we look at other more sucessful states adn see how it is they run their medicaid programs. If we dont pay for some of the basics such as dental care or rehab where does everyone think these people are going to go? We pay to bury the ones that die, we pay for their medical care in increased costs for us at the hospitals so they can make their profits, we pay in increased taxes to cover the nursing home bills and CPS/APS investigations. In the end we still pay. So lets pony up and cover the costs. Lets require living wages, lets require fair housing, "

 joy wrote on January 28, 2008 9:15 am:
" id rather my tax dollar go to pay a 53 dollar dental visit then the next time i have to go to the hospital have my 5300 bill reflect what it cost for the hospital to have treated an uninsured persons tooth ache "

 John Q Public wrote on January 28, 2008 9:21 am:
" Where do I sign up for these benifits, I have to work 45 hours a week and dont get free eyeglasses every year or a new hearing aid, I have to pay for these out of my pocket, I an tired of paying for these item for everyone else. Maybe we need more cuts like these. "

 Kid wrote on January 28, 2008 9:43 am:
" I agree these are very modest cuts. If you smoke crack and lose your teeth, medicaid covers for new teeth. Look at the indivdiuals who work full-time jobs, health insurance thru their jobs, and yet, they don't receive free care for dental work. I agree these individuals have financial difficulties, but I love it when I see someone on medicaid and they have a brand new car or they are toting around a very expense purse. How about that gal with the big honkin diamond ring, - oh yeah, they're on medicaid. Personally, I feel these individuals on medicaid need to have the same process as the VA. The individuals with insurance thru the VA have to jump thru hoops just to receive medical care, yet medicaid patients can come in the Emergency Room and be seen for a sore throat or a fever that they haven't even tried to take care of themselves. Ever heard of tylenol sore throat or tylenol period!! I bet if this medicaid program would provide a nurse on call that could give these medicaid patients advice before they show up in the Emergency Room, you would save tons of money right there. "

 ted wrote on January 28, 2008 10:59 am:
" What people do not understand is how will the state keep paying for these medical services? Medical costs keep increasing at 10% per year for the state budget, but state budget income has no mechanism to increase with costs. "

 Mother with Children on Medicaid wrote on January 28, 2008 12:22 pm:
" I have to say, I do understand where some people are coming from.
But heres a look from a different perspective... my husband did lawn care, and did not recieve health insurance from his job. He did lawn care for 9 months out of the year, and then had another job that we worked full time at for the 3 months... which he worked part time at during the 9 months.
We qualified for Medicaid when I was pregnant with my first, because we make below whatever the limit is. We currently have 2 kids with another on the way, and still qualify for medicaid... at least my kids and myself, until I give birth, then, I like my husband will not be covered.
I have never taken my kids to the ER unless it was absolutley neccessary... only once that has happened, and it was because my 2 month old couldn't breathe, so they had to check her for pneumonia.
I know that there are lots of people out there that abuse the system, but think about those of us that don't. I wear glasses, and with all three of my pregnancies, had the option that yes I could go and get new glasses. I didn't. And when I go see a dentist, it's for a check up... because did you know that any infection, even in the mouth, could cause a pregnant women to go into preterm labor?
I realize that there are plenty of people on MEdicaid that abuse it... but there are some of us that don't. I don't do anything different than what I would do if I had to pay for my own insurance.
And the whole jumping through hoops thing... there have been new stipulaitions and whatnot set up, starting at the begining of this year that make it so you have to send HHS your life story to get on medicaid! We were taken off for a breif time, and have been trying to get back on for over a month. Currently, my two kids ages 2 and under, as well as my unborn have no insurance whatsoever. We keep finding out from our social worker that there is more information that we need to send in.
It's crazy! But hopefully this weeds out the people who shouldn't be getting it.
Thanks for letting me share my opinion. "

 Why wrote on January 28, 2008 1:01 pm:
" Why would anyone think it's OK to cut rehabilitation services for the disabled? Could any of you look a disabled person in the face and tell them sorry, but you can't ever have a chance to recover because we won't help you. Please people, think with your hearts just once, not your bank account. "

 A lot of problems wrote on January 28, 2008 1:12 pm:
" A couple of things to ponder... One of the reasons we need health care reform throughout the country is directly related to needing to make cut backs in medicaid. It IS unfair that people paying tons of money for health insurance have to pay even more for basic needs, i.e. new glasses or dental visits. Private insurance companies, along with medicaid, need rennovations.
My son receives medicaid becuase he has disabilities. Unfortunately, unless I marry a rich guy and get an awesome job too... I will not be able to afford his care. Therfore, we have to stay under the income guidlines.
My sister is going to full time at her job and therefore, becuase of a $300.00 increase in monthyly income her 18 month old daughter will loose insurance, even though the job does not offer insurance.
Yes, people do abuse the system. When have we ever tried to educate them on when children or they actually need to go to the doctor?
Just cutting things will not fix the problem. Actual reform to the problem is the only way to go... "

 ENOUGH wrote on January 28, 2008 1:17 pm:
" What about the people that have disabilities that include many health care needs and have to rely on Medicaid for their healthcare coverage?

What ever happened to the philosophy that we take care of each other, no matter what their needs are? Today it all seems to center around what is in your checking account. We have moved back to the "me first" syndrome.

Let's face it the health care system of this state and this country is a total mess. When are we going to realize that corporations should not be running our lives and taking care of our health. We all have the right to get the health care that we need no matter our income.

When are people going to say ENOUGH? This state has a surplus and what are they doing with it. Not taking care of the citizens that need the help the most - People with disabilities, children and people that have low income. When is this state going to open it eyes and realize it needs to start taking care of it citizens instead of blaming them for their situation.

ENOUGH "

 Wise up Kid wrote on January 28, 2008 2:21 pm:
" Not every person who receives public assistance is abusing the system. In fact, there are many people receiving Medicaid and other public assistance benefits that are working full-time jobs which don't provide insurance. Decreasing benefits isn't going to prevent people from accessing services in the ER, it will actually increase the occurance of low income people showing up in ER for illness that could have been addressed at the much less expensive doctors offices. I am so discouraged sometimes when I read these blogs. When did it become a crime to be poor in the United States? It is not the people living inpoverty who should be looked down upon, it is those who have the capacity to make a difference and choose not to. Haven't you ever stood back and realized that there but for the grace of God is you in that persons shoes? "

 To Mother with Children wrote on January 28, 2008 3:06 pm:
" I have to say it. While I applaud your efforts to keep your Medicaid costs down, why are you then having more children you can't afford? My husband and I both work full-time. We have two children and would love to have a third. But guess what? We can't afford it, so we've made the decision not to have another child. In addition, I don't think it should be a cakewalk to get public assistance. Yes, it's difficult to have children and not have health insurance. But again, your husband chose not one but two jobs that didn't offer health insurance. And you both chose to have another baby. I hope you continue to use whatevery public assistance you are provided wisely. But more than that, I hope you and your husband work even harder to get end your need for public assistance. "

 Keb wrote on January 28, 2008 3:36 pm:
" Since when are braces considered "needed" dental care? I have two neighbors, both working, who have their kids on Medicaid. Their teens got braces FREE. Even with dental insurance we don't have the luxury of complete orthodontia coverage. Some modest modifications in regulation seem fair to me. "

 Publius wrote on January 28, 2008 4:13 pm:
" When we discuss the poor, it tugs at the heart strings when someone needs care they cannot afford.

At the same time, we know there are three things you can do to stay out of poverty: 1) finish high school; 2) don't have children out of wedlock; and 3) stay married. About 97% of people who follow those rules are above the poverty level.

Further, an overwhelming majority of the people who make up the poor end up leaving that group over time, as they develop skills and experience in the working world.

I don't mind helping the destitute, but Medicaid is expected to out pace aid to schools as the largest item on the state budget (www.NebraskaSpending.com). Health care is not a right. People need to start assuming the consequences of their actions and paying for the goods and services they consume.

There are options for those people with low incomes, such as community health centers. "

 To mother of children on Medicaid: wrote on January 28, 2008 4:29 pm:
" How do you continue to get Medicaid coverage for continuing to have MORE children when you are already receiving welfare? I thought welfare reform was suppose to stop this abuse. I am not wealthy, pay my own way and have to consider if I can afford to provide for another child before I have another child.....why do people think they should have MORE children they cannot support without welfare. If you already need welfare for your current children are you not taking limited resources away from your current child when you have more children. Thanks for having more for me to support with my tax $$ while I can not afford to pay for more of my own. "

 big surprise wrote on January 28, 2008 5:40 pm:
" When the Governor hired Chaumont to head Medicaid, her record was clear--she is the one you hire to cut services. She did it in each previous state, and she's here to do that for us. It's bad enough that we've allowed our state health facilities to deteriorate, so the mentally ill and developmentally disabled are suffering more than ever, but now we will add to this, our children, the most vulnerable group. And, sadly, the Governor continues to be supported by voters who like to pass off their short sighted greed, as 'responsible". Just watch, he'll be a senator someday, on your dime, at the expense of our poorest citizen's health. "

 Krae wrote on January 28, 2008 8:40 pm:
" I am quite suprised to hear that they want to cut chiropractic services. I have been told by two very good chiropracters that having a child who has had difficulty with ear infections adjusted regularly will actually PREVENT reoccuring ear infections and the number of visits to the doctor. Thus reducing the need for anti biotics to fight said ear infections. My children are on Medicaid not because we are very very poor but because we didn't have many other options. My husband and I are both employed and chose NOT to have any more children however something went wrong when my tubes were tied and 11 months after the birth of our second child I gave birth again. We did have insurance on the two children before the third one was born however because of the cost of the private health coverage(neither of our employer's offer family medical and it would have cost $600 plus for family medical)for all three children we did not have an option but to apply for help. We are both pro life and since we already had two children we didn't feel it appropriate to put the third one up for adoption. So this is one cut that I would hope people consider before it is made. If one visit to the chiropracter can save money in a Dr's office and the Pharmacey why not use it. In the long run the more saved there is more saved in Medicaid. "

 Tired of Whining wrote on January 29, 2008 7:45 am:
" I really think its time to stop putting quick "bandaids" on the problem and start looking at a long term solution. Why not simply put limitations on the types of things covered by emergency room visits? If someone has a sore throat or a slight fever and goes to the emergency room, they are not seen. If a mother of three has a child that can't breathe, obviously get them in and cover it. Lets take care of the waste and excess first and then see what we have left after. Or maybe give medicaid participants a copay just like the rest of us? Come on now, free Chiropractors? Give me a break. "

 Shadow wrote on January 29, 2008 8:24 am:
" one of the many problems is that the benefits are so good, "very" poor people dont want to get out of the rut. maybe cutting these benefits will help to spur some to try harder. i know hundreds of people that have quit jobs because the amount they made would make them inelgible for these benefits. I used to get them and i worked my but off to go to school, get a degree and get a job that provided me with the same (actually better) benefits. some people do get hit with unfortunate circumstances but these benefits are ment to be temporary to help you while you are getting back on your feet and not for the rest of your life. "

 Here we go again wrote on January 29, 2008 11:13 am:
" I think this is getting out of hand. Yes there are lots of things not covered with medicaid just like regular insurance. But dental being cut is bogus. People can die from a tooth infection.(i know someone who did because according to the state, he made "too much money" to get any type of help. I can see cutting back on eye care because those visits are not as much as a regular dentist or regular doctor. And with the chiropractors, there have been people who have been cured of migraines and such just to adjustments. I see where this is going. This extra money the state is supposed to save, will go into the bank accounts of the people who are cutting these things from medicaid. And for the rehabilitation, there are people who needs this in order to get back to everyday life. Not everyone works at jobs to where they can get regular health coverage through their employer so unfortunately, they have to rely on the state. Going through a private health insurance costs 10 times more than if you pay through an employer. I should know because i had to pay this out of my pocket until my husband was able to get insurance through his employer. I was paying well over $600 a month for insurance, versus paying $30 a week for his through the employer for the both of us. Instead of cutting out medical, why doesnt the state start cutting and cracking down on people who are on housing and abusing it????? Why not get on those people who sits at home and collects medicaid, food stamps, housing, cash assistance, and etc and does nothing???? "

 Avg Lincoln Taxpayer-Taxed To Death wrote on January 29, 2008 11:20 am:
" I seriously think this is really a modest cut in support. I wish they would do a lot more in benefit reduction, as they do get more benefits than the average working folk. Since when should they be held to a lower standard than the average "employed" person. I persoanlly think your "benefits" should be eliminated if you cannot follow basic rules OR keep having babies you cannot afford. Makes me sick! Oh yes, I think we aught to drug test them also before they receive a dime! Reminds me of starting a new job. Opps, I said a bad word... J.O.B. "

 Dont you wonder wrote on January 29, 2008 12:03 pm:
" If those who are trying to cut down cost of Medicaid have great health care for themselves? I bet they do. Although I do think that some abuse the system, I know a great many who do not. Do not fool yourselves if you honestly think trying to stay on Medicaid is easy, its a huge hassel. But I need to have my kids' on it because I cannot afford to have them on my health care plan. Luckily I can afford for myself to be on my plan at work, but many cannot. My kids dont go to the ER unless its an Emergency, they do go to the dentist every 6 months and normal doctor visits. Heath care is a must in this country, and people who have it sometimes take it for granted that "Hey, I got mine" attitude. Unless you have gone without a necessity like health care, you dont know how scary it can be to think it will be taken away from you. Its not a luxury that we can go without. For many parents like myself, either single parents or not, we need this for our kids. Do I think the crack head who rotted her teeth out should get a new set of choppers for free? NO I do not, but should her kids still get Medicaid? YES I DO "

 Lots to ponder wrote on January 29, 2008 12:47 pm:
" Mother of children on medicaid - good luck, and perservere. There will always be someone to belittle your efforts. I do agree that it is a parents responsibility to do everything within their power to provide for their children & seeking a job that may provide insurance consistently is vital. Even if you have the most minimal of coverage, at least some form of private health care is picking up a larger portion of the health care costs. Medicaid can then assist with the remaining portion - I think so many people forget that Medicaid does not need to be primary coverage, that it can be secondary to assist when absolutely necessary.

I also feel very strongly that the Medicaid system could be structured more like a normal insurance plan which limits how many visits you can make per year for certain things, has wellness benefits available, has co-pays if applicable and limits the amount of dental or eye care benefits available for a period of time.

Really, this isn't brain surgery, but as a nation - or even as a state for that matter, we're going to have to find common ground. Soon. "

 c wrote on January 29, 2008 1:28 pm:
" I work for a company that offers some of the best insurance in the city. But guess what. Out of pocket I pay over $200 a month for the insurance, then I have to meet the annual deductible, I have coverage limits and co-pays AND I have to pay for my prescriptions. This isn't about taking away services, this is about limiting non-essential services. I think that rehab needs to be left alone because this can help people with a disability in returning to work. But my dental maximum is $1500 a year and its not wide open coverage, I pay one rate for preventative work and one rate for restorative work and I know that if I'm not taking care of my teeth then I'll pay more. I also opt to pay for vision coverage on my insurance and we get new lenses annually and new frames every two years. It doesn't seem unreasonable to me that Medicaid is setting limits. If you don't like it then get a job and stop popping out babies and pay your own bills. "

 good idea wrote on January 29, 2008 2:54 pm:
" TO AJ...Cutting benefits for "the "very" poor!" Maybe some need some help but many people covered by medicaid abuse it on a weekly basis and don't attempt to get out of the rut they are in. Maybe less coverage would encourage some of them to strive to another level and provide those benefits for themselves. "

 Agree with John Q wrote on January 29, 2008 3:01 pm:
" I agree 100%. Not only do these people get a pair of free eyeglasses a year....but they claim they are lost for a second pair or decide they dont like the style anymore, break them, and medicaid covers yet another pair. Maybe if these people had to pay a portion of the services they had, they wouldn't abuse it. I work full-time to pay my bills and have insurance and I can only afford things like glasses every few years. I'd love to sign up for the benefits of medicaid and maybe then I could get new glasses every year and go to the dentist more often. "

 The Omega Man wrote on January 29, 2008 7:02 pm:
" I pay about 70 bucks a month for full family coverage and that price is locked for about 3 more years and I guarentee my health care coverage is better than 98 percent of Nebraskans. But it doesn't come close to covering what Medicaid covers. What a wasteful program "

 Lola wrote on January 29, 2008 9:30 pm:
" More than 51 percent of the state's Medicaid funds go to longterm nursing home care for the elderly. The people who gripe about helping the poorest children often benefit from Medicaid in the care of their parents, grandparents, etc. Denying dental care to the neediest violates the ideal of America and represents a false savings. Elections matter, people! "

 Susan Scherer-Hicks wrote on March 1, 2008 4:32 pm:
" I agree with Sen Annette Dubas of Fullerton's suggestion for the future Medicaid cuts report,60 day prior to the legislative session. Public discussion is needed. It is my belief that we Nebraskans do not understand how we are all connected when we provide for those disabled. "

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