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Kansas Medicaid Cuts Expected To Hinder Access To Care

Dec 08, 2009

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TOPEKA - Consumer advocates and others say it will only become harder for low-income Kansans to get medical services now that the state is cutting Medicaid payments by 10 percent.

“Let’s be honest about this,” said Corrie Edwards, executive director of the Kansas Health Consumer Coalition. “Doctors are not taking any more Medicaid patients right now. They’re not.

“I was in Ashland (52 miles southeast of Dodge City) two weeks ago and there’s nobody there who’ll take Medicaid,” Edwards said. “The closest doc is two hours away — that’s two hours one way.

“It’s the same in Wichita or Topeka,” she said. “You can spend hours on the phone trying to find somebody who’ll take Medicaid.”

Physicians and hospital officials have long complained that Medicaid doesn’t cover their costs.

Cutting payments by 10 percent, Edwards said, will make a bad situation worse.

Gov. Mark Parkinson last month ordered the cuts in reimbursement rates to doctors, nursing homes and other providers as part of ongoing efforts to keep the state budget balanced.

The state faced about $258 million in red ink and the state constitution requires a balanced budget. The cuts ordered by the governor touched virtually every department and state office, not just the Medicaid program, with major cuts also ordered in education spending and highway maintenance.

In earlier rounds of cuts this year, state officials avoided reducing Medicaid reimbursements, but the governor said this time he was left with no good choices.

"There's no way to sugar coat this," Parkinson said. "This will have very negative effects across the state."

Kansas Health Policy Authority officials said last week that the reimbursement reductions will apply for all services provided after Jan. 1.

Harder On Some

The cuts are expected to fall especially hard on children and mothers.

Almost two-thirds of the state’s Medicaid population is comprised of children and pregnant women. The rest are either elderly or disabled. All are low-income.

In Kansas, childless, non-disabled adults are not eligible for Medicaid.

“The physicians who are going to be affected the most by this are those whose practices are in high Medicaid-volume areas, like in some of the urban areas,” said Kansas Medical Society Executive Director Jerry Slaughter. “Pediatricians, obviously, will be, too.”

“People need to understand that before this cut, Medicaid paid about 65 to 75 percent of what a private insurer paid,” said Dennis Cooley, a Topeka pediatrician and president of the Kansas Chapter of the American Academy of Pediatrics. “At the same time, a typical primary care practice’s overhead costs come in at around 60 percent. So when Medicaid takes a 10 percent cut, that means you’re either seeing (patients) for free or you’re paying to see them.”

Cooley said he expects pediatricians now will accept fewer Medicaid patients. Some, he said, will decide to stop seeing them altogether.

“That’s my biggest fear in all this,” he said. “Because when that happens, more and more of these folks are going to turn to the local health department or the safety-net clinic, which, let’s not forget: Their funding is being cut, too.

“Pretty soon, they’ll be overrun and then there won’t be any place for these folks to go but the emergency room, which, as we all know, is the most inefficient, most costly place to receive care,” Cooley said.

Eventually, he said, the cut’s short-term savings will fall far short of the long-term costs.

“I understand the difficult situation the state is in,” Cooley said. “But a 10 percent cut is going to end up costing us a lot more than it’s going to save.”

Pain For Hospitals, Too

Hospitals also are worried.

“It’s still too early for (hospitals) to know how they’re going to respond to this,” said Tom Bell, executive director at the Kansas Hospital Association. “But a 10 percent cut is going to be very difficult to absorb. I suspect they’ll be taking a pretty close look at whatever services don’t provide the kind of margin they need.”

Bell and Slaughter said their members have been calling wanting to know if the cuts are likely to deepen in the months ahead.

“I don’t know that anybody knows the answer to that at his point,” Bell said.

“The thing I’m hearing about the most is that if this was a 5 percent cut and took effect in July 2010, (physicians) could plan for it or make adjustments,” Slaughter said. “But this is 10 percent, effective immediately. There’s no way to plan for it. So now they’re saying ‘Is this it? Or is it going to get deeper as we go along?’

“All we can say is we just don’t know,” he said. “It’s pretty frustrating.”

Dr. Vernon Millis, a Leavenworth pediatrician and a member of the Kansas Health Policy Authority board, said he had no plans to see fewer Medicaid patients.

“We’ll try to cut a few things here or there, but, frankly, we won’t change much,” Mills said. “All we can do, really, is just grin and bear it just like we have for the last 25 years.”

Now that it’s winter, he said, demand for back-to-school physicals and checkups has passed.

“Most of the kids who are coming in are coming in because they’re sick,” Mills said. “I have to see them. I don’t have an option.

“Let’s not forget who we’re talking about here,” he said. “These are children. They don’t have a say in these decisions, it’s the adults who are making the decisions and who keep saying how much they value children and then they turn around and cut education and Medicaid. I’ll have no part of that.”

KHI News Service specializes in coverage of health issues facing Kansans

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