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.

“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.