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Planned Medicaid cuts hit dental, home care

Patrick must trim $117m; higher copays expected

By Kay Lazar
Globe Staff / November 14, 2009

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More than a million low-income Massachusetts residents covered by Medicaid would be required to pay more for visits to certain doctors and receive prior approval for some expensive psychiatric medications under a plan announced yesterday by the Patrick administration to narrow a $307 million shortfall in the state’s MassHealth program.

Some of the biggest changes are in dental care for adults, who would no longer receive dentures or other oral care except for cleanings, X-rays, and emergency services.

That change alone is expected to save about $15 million this fiscal year, said interim Medicaid director Terence Dougherty.

Under the proposals, the state will also stop paying for personal care attendants for patients requiring the in-home aides less than 15 hours a week.

Medicaid is jointly financed by the state and federal governments: For every 38 cents the state spends on MassHealth, Washington chips in 62 cents, so Massachusetts has to come up with savings of about $117 million.

Dougherty said the administration’s strategy was to avoid, as much as possible, eliminating programs and instead to reduce services across a broad spectrum.

“I think the very design the governor put out to us was to ensure that necessary services remain intact and that we don’t outright eliminate things,’’ said Dougherty. “That’s about the only solace I can offer anybody.’’

Dougherty said the recession and widespread job losses have swelled the number of residents seeking assistance through the Medicaid program by more than the Patrick administration anticipated when it put together this year’s budget proposal a year ago.

Today, more than 1.2 million residents are receiving Medicaid assistance, up 115,000 from a year ago.

At the same time, the administration is struggling to plug a $600 million gap in the rest of the state budget.

Dougherty said that copayments for office visits to specialists would double, to $6. Most patients would pay about $1 more for generic medications, and copayments for brand name drugs would jump from $3 to $5 for people who make more than about $15,000 a year.

The state also wants mental health patients to get prior approval from MassHealth before they can fill prescriptions for certain brand name antidepressants and other psychiatric medications if comparable generic drugs are available.

Advocates for the poor, disabled, and elderly criticized the proposals, saying the administration was attempting to balance the budget on the backs of the state’s most vulnerable citizens. The cuts to dental care and in-home health services, they said, would be especially painful.

“Dentures aren’t a luxury,’’ said AARP Massachusetts state director Deborah Banda. “And if you are someone who relies on a personal care attendant to help you get out of bed or to the bathroom, that’s not a luxury either.

“Before the Commonwealth takes one more basic necessity away from our most vulnerable residents,’’ she said, “let’s exhaust every other option.’’

Mike Fadel, vice president of 1199 SEIU, a labor union representing many health care workers, said, “As caregivers, our members see first-hand how cuts of this nature threaten the health, safety, and independence of seniors and people with disabilities across the Commonwealth.’’

Also drawing stinging reaction was the administration’s proposal to eliminate all of the funding for nursing home pre-screening, a $2.5 million cut that advocates said could force many more seniors into nursing homes. The counseling explores other options that can help people stay at home longer, such as personal care services.

“This program is a money saver, because it diverts people from nursing homes,’’ said Al Norman, executive director of Mass Home Care.

The cuts identified so far, which also include some reduced payments to hospitals for patients who stay beyond 20 days, add up to about a third of the savings needed.

Dougherty said his agency will also be scouring its budget to make sure the federal government is reimbursing the state for the full amount it is owed, and he intends to ask state lawmakers for a modest cash infusion, though he declined to elaborate.

Dougherty said the proposed increases in patient copayments, cuts in dental services, and the elimination of the nursing home prescreening probably will not go into effect until April because state lawmakers must first approve the measures and then hold public hearings. He said he expects legislators to vote next week.

State Senator Steven Panagiotakos, chairman of the Senate Ways and Means Committee, said the proposed cuts were difficult, but given the enormity of the state’s fiscal problems and the fact that lawmakers had already borrowed heavily from the rainy day fund, they had limited options.

“The bottom line is we have no margin of error this year,’’ he said.

But Panagiotakos also said that the proposed elimination of the nursing home screening program concerned him.

“That is a program,’’ he said, “that may be able to save us money.’’

Kay Lazar can be reached at klazar@globe.com.

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