HARD TIMES TAKING SOME OF THE
AID OUT OF MEDICAID
By Elizabeth
Simpson
The
Virginian-Pilot
James Parker cringes when he
thinks about cuts to Medicaid insurance that
could make it even harder to get the medical care he needs.
The 54-year-old Norfolk
resident has multiple sclerosis and receives primary care at a
community health clinic. When he needs a specialist, however, it's a
fight to find a doctor who will see him.
He's one of more than 775,000
Virginians covered by Medicaid, a shared state and federal insurance
program for the disabled and people with low incomes.
The ailing economy is putting
the program under unprecedented pressure for two reasons: More people
are qualifying for the insurance because they're losing jobs or
earning less; and state legislators facing budget shortfalls are looking for ways to cut Medicaid
expenses by curtailing services or reducing reimbursements to
health-care providers.
The Medicaid program already
pays doctors and hospitals much less than private insurance does -
below actual costs in most cases. Many doctors, therefore, do not accept
Medicaid patients or restrict their practices to a certain number.
In Virginia, both the House
and Senate budget proposals included cuts in reimbursements to
hospitals and doctors, though they differ in how much. Legislators,
who will take up the issue of the budget again today , hope
federal funding will come through to help make up for some of the
proposed Medicaid reductions.
Cuts also are being considered
for FAMIS, the state's health insurance program for low-income
children and pregnant women. Reductions in health care
for low-income populations are likely to have ripple effects.
Parker's physician, Dr. Subir Vij, would deal
with them firsthand. "We're already seeing more people with
Medicaid and more people who are uninsured," said Vij, an internal medicine doctor who practices at
Park Place Medical Center in Norfolk. "They had a nice job with
insurance, but then they lost their job, and their doctors kicked
them out."
About 25 percent of patients
who visit the community health center are on Medicaid, a higher rate
than at a typical family practice. An
additional 40 percent are uninsured. Community clinics are
federally funded and do not turn away Medicaid patients.
Still, growth and possible
reimbursement cuts could translate into longer waits.
Two years ago, for instance,
it took about two weeks for a new patient to get an appointment. Now
it can take six weeks. In 2009, the number of patient visits at Park
Place and its partner center, Portsmouth Community Health Clinic, was
38 percent higher than the previous year.
Many Medicaid patients arrive
after being turned down by other doctors.
The same trend is unfolding
across the nation as the number of people on Medicaid grows.
A survey released last month
by the Kaiser Family Foundation found a record one-year increase -
3.3 million patients - in Medicaid enrollment from June 2008 to
June 2009. Virginia's growth was 8.2 percent, higher than the
national average of 7.5 percent. Nearby Maryland saw a 20 percent
jump, the highest in the nation.
Because Medicaid enrollment
often lags behind a rise in unemployment, an even bigger increase
could occur this year, according to the analysis.
Virginia legislators had
proposed Medicaid reimbursement cuts to hospitals last year, but
federal stimulus money helped fill the gap. Portsmouth Community
Health Clinic also received about $219,000 in stimulus money last
year, which allowed for the hiring of another doctor and support
staff.
That stimulus assistance is
due to expire at the end of December. Although
Congress and the White House are considering extending the
payments for six more months, they haven't done so yet, leaving
legislators across the country struggling to make their budget
numbers work.
In the Kaiser survey, every
state's Medicaid enrollment rose, and in 32 states, including
Virginia, enrollment grew twice as fast as the year before.
Virginia already ranks 48th in
the country in Medicaid expenditures per capita, according to a 2008
Joint Legislative Audit and Review Commission fact sheet. And every
dollar cut from state Medicaid results in a loss of at least that
much in federal matching money.
Barbara Willis, chief
executive officer of the community health clinics in Portsmouth and
Norfolk, worries that doctors will be even more hesitant to take on
Medicaid patients if reimbursements decline any further. Then more
people would turn to community health centers, increasing wait times,
or go without care until they were so sick they needed to go to
emergency rooms.
Parker, like many patients,
can find primary care at community health clinics, but he sometimes
has a harder time with specialty care. He needs to see a urologist, but the practice he was referred to
several months ago was not taking any more Medicaid patients.
"I'm still looking for someone," he said.
Willis said some practices cap
how many Medicaid patients they'll take, and patients who call after
the limit has been reached are turned away.
Some doctors cannot, or will
not, turn away Medicaid patients.
For instance, pediatric
specialists who work for Children's Specialty Group base their
practices at Children's Hospital of The King's Daughters, where about
half the patient visits are paid for by Medicaid. Children are more
likely to be eligible for Medicaid than adults, so that's where most
of the growth in enrollment is occurring.
Frank Singleton, CEO of the
specialty group, said the doctors will
not turn away Medicaid patients, which means a reimbursement cut
would hit them harder than pediatricians or family practice
doctors who choose to restrict their practices.
Emergency room physicians also
would bear the brunt of lower reimbursements.
Gwen Harry, executive director
of the Virginia College of Emergency Physicians, said that specialty is legally bound to care for whoever comes
into the emergency room. Further, more people unable to find a doctor
who will take Medicaid might wait until they are sick enough to end
up in the ER.
"That ends up impacting
not just the Medicaid patients," Harry said, "but everyone
else who needs care there."
WHAT IT MEANS
Growth in Medicaid rolls and
possible reimbursement cuts could translate
into longer waits and more doctors turning away patients.
WHO IS AFFECTED
More than 775,000 low-income
and disabled Virginians are covered by Medicaid.
WHERE VA. STANDS
For a state-by-state
comparison of Medicaid enrollment, visit the Kaiser Family Foundation
Web site, Medicaid Enrollment, June 2009 Data Snapshot.
