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PROVIDERS SAY MEDICAID TRIMS WILL HINDER SERVICES
Author(s): Alice Dembner,
Globe Staff Date: January 31, 2003 Page: B8
Section: Metro/Region Doctors and nursing
homes will bear the brunt of the $114 million in Medicaid cuts
announced by Governor Romney's administration yesterday, making it
likely that some providers will quit serving the poor or shut their
doors altogether, health care providers said.
The Medicaid cuts represent the biggest chunk of $172 million
the administration plans to take from health and human services in
an effort to balance the budget. The reductions also suspend
enrollment in a discount drug program for the elderly, eliminate
some school nurses, cut deeply into AIDS prevention, and pare
millions from departments serving mentally ill and mentally retarded
people and abused children. Eric Kriss, secretary of administration
and finance, said that because most of the human services cuts were
in administrative expenses or payments to service providers, they
would have little effect on the care received by the state's
neediest citizens. "There is no reduction for homeless
shelters . . . in welfare or veterans benefits or for emergency aid
to the elderly, disabled, and children," he said, adding the cuts
represent only 1.3 percent of the $10 billion health and human
services budget.
But critics said the cuts, coming on top of $500 million
sliced from those same budgets over the last two years, would hurt
many low-income families.
"I don't think you can get much deeper into the core than the
prescription program and Medicaid," said Senator Mark Montigny, a
New Bedford Democrat who served as chairman of the health care
committee. "If we're lucky, we pay more to serve them in hospital
emergency rooms, and if we're unlucky they die."
Doctors, hospitals, and nursing homes have long complained
that state Medicaid payments fall short of covering their costs.
Yesterday, Kriss said the state would immediately cut those payments
by 3 to 5 percent, saving about $65 million. In addition, he said,
the governor would seek legislative approval to cut another $23
million that was promised to nursing homes under a user-fee program
devised last year to leverage more federal money for strapped homes.
Health care providers said the cuts would push some out of
the business entirely, while forcing others to raise costs or cut
services to other patients to cover the added expense of caring for
poor people. "There's no cushion now," said Scott Plumb, senior vice
president of the Extended Care Federation, which represents nursing
homes. "There will be reductions in staff and hours and that will be
reflected in poorer care."
Plumb said Medicaid pays the nursing homes about $20 per day
less than it costs them to care for patients, and said he feared
some homes would be forced to close. Dr. Charles Welch, president of
the Massachusetts Medical Society, said Medicaid already pays about
25 percent less for each patient than Medicare or private insurers
and said that more doctors would stop taking Medicaid patients.
"It's not just that physicians drop out of Medicaid. They
simply drop out altogether - retire early or move out of the state,"
said Welch. "It's already hard for Medicaid patients to find routine
primary care in some areas."
In Boston, 11.8 percent of doctors were not accepting new
Medicaid patients in 2002, up 3.3 percent from 1997, according to
the Center for Studying Health System Change, a nonpartisan research
group in Washington, D.C.
Federal law requires hospitals to continue to serve Medicaid
patients no matter how low their reimbursements, so hospitals will
have to adopt cost savings that affect all patients, said Ronald
Hollander, president of the Massachusetts Hospital Association.
Medicaid in Massachusetts pays hospitals about 75 percent of
their expenses, Hollander said, while Medicaid programs in New York
and Texas give hospitals slightly more than their cost.
Health and Human Services Secretary Ronald Preston said he
was worried providers might drop out of the Medicaid program, but
hoped their dedication to serving the poor would lead them to stay.
"By and large, we tried to spread the pain in such a way that
everybody remains viable," he said. "It's always a game of poker."
Alice Dembner can be reached at Dembner@globe.com.
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