Published Wed, Oct 14, 2009 07:42 AM
Modified Wed, Oct 14, 2009 05:47 AM
Strained Medicaid in for cuts
North Carolina is trying to squeeze savings out of Medicaid, even as
people than anticipated sign up for coverage under the government
health-care program for the poor.
So far, the cuts primarily mean that doctors, hospitals and providers
being paid less for their services, but state officials and others are
warning that cuts to medical services and significant job losses in
care could be looming.
Cuts ordered by the legislature this year mean that Medicaid, which is
funded jointly by federal and state government, will lose $1.5 billion
Those cuts have touched nearly all areas of health care. Doctors and
hospitals are being paid less to treat Medicaid patients, and the state
spending less on community mental health and personal care services for
Meanwhile, more people are asking for help. About 8,000 more people than
legislators budgeted for were signed up for the government insurance
in August, and September enrollment was 3,000 people higher than
Unless there's a dramatic economic turnaround in the next year, the
pressure could increase, said Lanier Cansler, head of the state
of Health and Human Services, which oversees Medicaid.
The state is expected to get $440 million less next year from the
government to fill Medicaid budget holes, he said, which may mean
legislators will have to consider cutting medical services.
"We're at the point to where we're not going to be able to keep access
place if we reduce the budget substantially more," Cansler said Tuesday.
Department administrators also worry that some doctors may decide to
treating Medicaid patients.
"We've got a tremendous challenge this year," Cansler said. "The
will just be multiple next year."
This year, most of the state's 1.4 million Medicaid recipients -- those
use the insurance for routine health care -- won't feel the pinch,
But doctors, hospitals and health agencies that care for them will get
money to do so, and paid caregivers will be watched more closely as the
state tries to contain costs by making sure patients don't get
they don't need.
Hospitals, mental health providers and home health agencies anticipate
thousands of job losses as a result of rate reductions and program
Mental health to be hit
Mental health providers who call the budget and program cuts "an
of destruction" will hold a news conference today to demand the
call a special session to restore mental health money.
Late Tuesday, Gov. Beverly Perdue announced that DHHS has been told to
an additional $15 million to cushion the drop in community mental health
spending. This year's Medicaid cuts in mental health came to $400
Hospitals expect to cut about 400 jobs because of the cut in Medicaid
payments, said Don Dalton, spokesman for the N.C. Hospital Association.
of those losses will be from rural hospitals.
The recession has already forced hospitals to cut staff, Dalton said,
lower Medicaid payments only add more pressure.
"These will force administrators and trustees to make hard decisions on
services to eliminate in their communities," he said.
The home health care industry expects substantial job losses, with fewer
patients receiving home care and agencies earning less money for them.
Up to one-fifth of the state's 100,000 home health employees could lose
their jobs as a result of state and federal cuts, with the state budget
reductions responsible for about 80 percent of the loss, said Tim
chief executive officer for the Association for Home & Hospice Care of
For elderly people who have trouble getting in and out of a bathtub or
the bathroom, the state wants to replace home care workers with bathroom
bars and raised toilet seats, Rogers said.
"They're trying to replace caregivers with pieces of equipment," he
"That's not the right thing to do."
Everyone wants Medicaid services to stay the same, Cansler said, but
"The system can't stay the same when we're taking the amount of dollars
of it the legislature has required us to take out of the system because
the budget crisis," he said.
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