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Thousands of Illinoisans to be affected by Medicaid cuts

SR-J.com reports:

“Beginning today, Larry Bonner must make sure he gets prior approval from the state to continue receiving the prescription drugs he needs for chronic pain, asthma, arthritis, diabetes, heart problems and mental illness.

As $1.6 billion in cuts to Illinois’ Medicaid program take effect, Bonner is among 200,000 people who will have to work with their doctors to obtain authorization from the state if they need more than four prescriptions.

Bonner, 56, of Springfield, has been unemployed for years and lives on food stamps and federal disability payments related to his health problems. He takes more than 20 prescription drugs.

Now, he worries that he or his doctors will slip up on paperwork needed to meet the new state requirements. That would result in him going without his medicine, at least temporarily.

“That wouldn’t be pretty,” he said. “I live in pain constantly, every day. I can’t go without my medicine.”

The cuts in Illinois are among the most severe in recent memory. They take effect only days after the U.S. Supreme Court upheld the constitutionality of a federal law, the Affordable Care Act, that is expected to bring a major expansion of health-care coverage in 2014.

Illinois’ cuts, approved by the General Assembly and Gov. Pat Quinn for fiscal 2013, were in response to a multibillion-dollar budget deficit and a huge backlog of Medicaid bills, all made worse by a sagging economy.

The 200,000 people to be affected by the prior-approval rules represent about 7 percent of the 2.7 Illinoisans on Medicaid, a program funded in almost equal parts by the state and federal government.

Too generous?

The cuts to medical-assistance programs will remove 26,400 working parents from the FamilyCare insurance program, saving the state $50 million.

Medicaid payments to hospitals, nursing homes and supportive living centers will be reduced, and there will be many cuts in specific health-care services.

Most dental services for adults on Medicaid will be eliminated, except in emergencies, so the state won’t pay for fillings, crowns or dentures but will pay for teeth to be pulled.

And the Illinois Cares Rx program, funded exclusively with state dollars, is no more, saving an estimated $72 million. At least 145,000 senior citizens and people with disabilities enrolled in the program will have to pay more — sometimes hundreds of dollars more each month — for their prescription drugs.

“It’s really unfortunate that we’re cutting health care at a time when having health care for everyone is on the horizon in 2014,” said Margaret Stapleton, director of community justice at the Chicago-based Sargeant Shriver National Center on Poverty Law. “That causes suffering and death.”

The Quinn administration realizes that the cuts will cause hardships, said Mike Claffey, spokesman for the Illinois Department of Healthcare and Family Services.

“We had to take these steps to sustain the Medicaid system,” he said.

Some observers have said Illinois’ Medicaid program was more generous than those in many other states before the cuts.

“That Illinois might be better than some other states isn’t saying that much,” Stapleton said. “If you don’t have health insurance, you live in dread.”

Few other options

Illinois’ Family Care program used to provide medical coverage to parents with children at home if the family income was below 185 percent of the federal poverty level, or less than $42,640 a year. Before eligibility levels were tightened in 2009, the program was serving some families making up to 400 percent of FPL.

The new eligibility limit is 133 percent of the poverty level, or $30,657 for a family of four.

Most parents cut off from the program work in low-wage jobs with few or no benefits, said Larry Joseph, director of fiscal policy at Voices for Illinois Children.

The cuts are taking effect at a time when 3,000 to 4,000 children in Illinois are losing All Kids coverage because of the state’s 2011 Medicaid reform law. But Voices for Illinois Children is glad that the recent budget cuts didn’t make more reductions in All Kids and cause more severe cuts affecting children overall, Joseph said.

The group remains concerned, however, about $15 million in reductions to a program that helps 600 medically fragile children who remain in their homes rather than in nursing homes or hospitals, he said.

Increases in cost-sharing for the children’s families “is going to cause, in many cases, severe hardships for them,” Joseph said.

The state also is instituting slightly higher co-pays for prescriptions and visits to the doctor and hospital ER.

More ER visits?

Six other states require prior authorizations for Medicaid patients who need more than four prescriptions — Kentucky, Louisiana, South Carolina, Texas, Utah and West Virginia. But in those states, the requirement doesn’t apply to children, so Illinois is breaking new ground, Joseph said.

Voices will monitor whether the administrative hurdles Illinois is erecting will result in children being denied necessary drugs, he said.

Healthcare and Family Services officials say the prior-authorization system is designed to reduce errors leading to unnecessary medications. But David Vinkler, associate state director of AARP Illinois, said problems for patients will be inevitable.

“The real savings comes in delaying people from getting medications they need,” Vinkler said.

Elimination of adult dental coverage, designed to save $35.4 million annually, will result in more people showing up at hospital emergency departments with severe pain from untreated dental decay, so the state will end up paying for more ER visits, according to Greg Johnson, executive director of the Illinois State Dental Society.

Capitol Community Health Center, a federally subsidized outpatient clinic at 2239 E. Cook St., will continue to serve Medicaid patients who lose their FamilyCare or dental coverage, center officials said.

However, Capitol used to not charge co-payments for those patients. Now they will be charged based on a sliding scale that results in most uninsured patients paying $20 to $25 per visit, according to Heather Burton, the center’s development director.

Koushan Azad, owner of Familia Dental, which serves Medicaid patients at its clinics in Springfield, Peoria, East St. Louis and the Chicago area, said his business will feel some financial impact from the cut in adult dental services.

“It’s definitely not going to drive us bankrupt,” he said. “The major impact is on the patients.”

Forgoing drugs

Senior Services of Central Illinois in Springfield is counseling Illinois Cares Rx patients on ways to change their Medicare Part D plans and apply for charity-care programs to reduce the out-of-pocket payments that Illinois Cares used to help cover.

Some clients will have to pay $300 or more per month in new out-of-pocket costs, said Beth Monnat, Senior Services’ pharmaceutical assistance specialist.

“We’ve already had people telling us that they’re not going to take their drugs,” she said. “I have a couple people a day tell me that.”

Bonner said Illinois’ fiscal problems don’t justify harming poor people when there is plenty of frivolous spending that could be trimmed instead.

“This state has always cried ‘broke’ for one reason or another,” he said. “I don’t think that it’s fair. A lot of people are going to have to suffer.””