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PROVIDERS SAY MEDICAID TRIMS WILL HINDER SERVICESAuthor(s): Alice Dembner, Globe Staff Date: January 31, 2003 Page: B8 Section: Metro/RegionDoctors 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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