Medicaid patients are among the most vulnerable populations in Alabama, and now the state legislature's decision to cut program funding could jeopardize their medical care for years to come.
A 30 percent cut in Medicaid reimbursements went into effect on Aug. 1 after state lawmakers slashed Alabama Gov. Robert Bentley's initial budget request. Rather than the $785 million Bentley's budget proposal sought for Medicaid, the state legislature approved only $700 million, leading to a veto by Bentley that legislators overrode.
The cut also puts at risk $350 million in matching funds from CMS.
"Every year there is a battle to get Medicaid fully funded," Alabama AFP President Jarod Speer, M.D., told AAFP News. "It's always under threat. The 11th hour came and went, and we didn't get a solution like we did in years past."
- After cutting Medicaid reimbursements by 30 percent as of Aug. 1, Alabama lawmakers now have been called into a special legislative session to consider ways to restore that funding.
- Family physicians in the state are on the forefront of a public campaign to reverse the cuts.
- Medicaid provides coverage for an estimated 1.2 million Alabama residents, including 50 percent of children and 60 percent of individuals in nursing homes.
In response to the threatened shortfall, Bentley convened the legislature for a special session(governor.alabama.gov) that began today during which he is asking lawmakers to consider two items:
- a constitutional amendment introduced Aug. 5(governor.alabama.gov) that would establish a statewide lottery, with proceeds going to the state's general fund, and
- legislation to cover the Medicaid shortfall.
Effects on the Ground
The legislature's move hit primary care physicians hard, forcing some to face difficult choices regarding practice management, and spurring many family physicians to press their legislators to find more money.
Family physicians from the Alabama AFP spoke in favor of restoring Medicaid funding at five press conferences hosted by a coalition of medical associations across the state this month. They urged residents to tell their legislators to close the $85 million shortfall in state Medicaid funding.
Speer, who spoke at a press conference in Birmingham, said the cuts forced him to lay off a nurse practitioner, and now his practice can see only half of the 12 to 15 Medicaid patients who used to come in each day. Medicaid is already the lowest payer in the state, and such low reimbursements make it difficult for practices to meet costs, he said.
After the practice reaches the limit of Medicaid patients it can see in a day, others will be scheduled for later, Speer explained. He noted that dropping Medicaid patients altogether would not serve his community well.
"I never had to turn patients away," Speer said. "We are always eager to see patients. This is all new to me."
Fallout for State's Residents
Medicaid provides coverage for an estimated 1.2 million Alabama residents, including 50 percent of children and 60 percent of individuals in nursing homes.
Federal funding that sustained Medicaid payments for specified primary care services at Medicare levels expired at the end of 2014 despite calls for an extension from the AAFP and other medical organizations.
Although Alabama legislators say the portion of the state's general fund budget allotted to Medicaid rose from 15 percent in 2007 to an expected 30 percent in 2017, former Alabama AFP President Beverly Jordan, M.D., told AAFP News that the comparison is flawed because state revenues fell as the economy weakened during that period.
"What we see as physicians is very different from what the general public and our legislators see," Jordan said. "We are covering people who are least able to care for themselves and be advocates for their own care."
Jordan's practice of four primary care physicians and three nurse practitioners will continue to see its current Medicaid patients but will not accept new ones. She said a 30 percent cut in Medicaid reimbursements means it costs the practice more than it is paid to care for Medicaid patients.
"The main purpose of the press conferences was to raise awareness about what truly will happen if we don't fund our Medicaid program," said Jordan, who spoke at a press event in Dothan. "Several legislators told us they are not hearing an outcry from the community. People aren't aware of how much Medicaid really does in the state."
Jordan said the state's only children's hospital might be forced to close if the shortfall is allowed to stand. Coverage for outpatient dialysis, prosthetics and orthotics may be cut, as well as that for eyeglasses, dental services and prescription drugs for adults.
Also in jeopardy is the state's plan to set up nonprofit regional care organizations, which are intended to be care coordination centers similar to accountable care organizations that would lower overall health costs. The state received a federal waiver for their implementation, but the plan will be halted if Medicaid is not fully funded.
"We need to find a short-term solution or we will spend years rebuilding the infrastructure that we lost because of the loss of funding," Jordan said.
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