Alabama--has no spend down, an aged/disabled level of $674 (the SSI rate), a parent level of 11%/ 24% if wkg (‘10) & an ADAP level of 250%; covers 12 MD visits & hosp days/yr & 5 brand name Rx’s/mo but has no MSP asset tests. Medicaid’s 2011 shortfall is $64 million. Gov. Riley (R) & the old legislature (D) cut HIV care $2 million but it overrode his veto to raise CHIP’s 200% level to 300%. The risk pool had once planned low income premium discounts but has no Medicare supplement. 2,500 are on the HCB waiver wait-ing list and incoming Gov Bentley & the new legislature (both R) favor deep health cuts.

Alaska---this Title XVI state has no spend down; an aged/disabled level of $1,252/mo (its SSI/SSP rate), a parent level of 77/81% if wkg (‘10), a 300% ADAP level, a risk pool with a Medicare supplement but no low income premium discount & a token SPAP for those under 175% that excludes the disabled. In spite of a $60 million 2011 deficit, Gov. Parnell (R) & the legislature (R House; tied Senate) raised the 175% CHIP level to 200%.

Arizona--covers parents & childless--even non-disabled--adults under100%/106% if wkg.  The CHIP level is 200% & ADAP’s is 300%.The legislature (R) killed a program covering the disabled during the 2 yr Medicare wait, cut MD fees & personal care funds but gave up up on dropping 310,000 clients or killing CHIP. With a budget short billions, Gov Brewer   (R) cut ADAP’s formulary & is consdiering starting a waiting list, mental health funds &   home care, ended hospice & non-emergency transportation; and kept a CHIP freeze that’s   cut enrollment from 45,800 to 33,700 since 1/10, with a waiting list of 40,000. She ended  adult coverage of physicals, podiatry, most dentistry, dentures, transplants, medical equip, insulin pumps, hearing aids, cochlear implants & computerized lower limb & joint prosheses & cut the time limit to get TANF from 60 to 36 months. Courts barred other cuts.

Arkansas—has an aged/disabled level of $674 (the SSI rate), a parent level of 13%/17% if wkg (’10), a monthly numerical Rx limit & an insurance subsidy for workers below 200% in participating small firms. Gov. Beebe & the legislature (both D) covered adult dentistry & passed an unfunded bill to raise CHIP’s 200% level to 250%. The risk pool bans Medicare patients but plans to get funding for low income premium discounts. Beebe may have to reduce the number of covered MD visits & Rx’s and had to cut ADAP’s formulary & its income level from 500 to 200%.

California-- The state covers the aged/disabled under 100% (with a $230, not just a $20, disregard), parents below 100%/ 106% wkg & prostate cancer patients under 200%. ADAP’s level is 400% & CHIP’s is 250%. With a $19 billion deficit, outgoing Gov. Schwarzenegger (R) & the legislature (D) raised premiums; capped child dental care at $1,500-$1,800/yr; dropped adult dental, podiatry & psychiatric benefits; ended non-emergency care for legal aliens; and cut provider fees & the HIV budget (with $12 million from ADAP---but most of that was later at least temporarily restored). A $2.75 billion Medi-aid cut dropped 3  million adults. He denied ADAP to county jail inmates & proposed ending some parents’ eligib-ility, home health care & personal aides for the disabled, low income clinic funding, adult day health care, limiting non-“life-saving” Rx’s to 6/mo & MD visits to 6/yr and imposing $50 ER co-pays,.MD & hospital fee cuts; ending adult day care & optometry; & a 20% personal aide pay cut. LA Co’s Health Dept has a $389-$429 million 2011 shortfall that could cut clinic patients served by 1/3 to ½. Courts barred dropping adult podiatry, chiropractic & dental services until CMS ap-roves. The new budget cuts HIV care $52 million, but incoming Gov Brown (D) favors protecting the health safety net.

Colorado---has no spend down. The level for those over 60 is $699 (their SSI+ SSP rate), but it’s only $674/mo (the SSI-only rate) for younger disabled. ADAP ‘s level is 400%. The risk pool has low income premium discounts for those below $50,000 & Medicare supplements. Outgoing Gov Ritter (D) began a formulary, made health plans cover PTSD, anorexia, substance abuse & colorectal screening, proposed de-funding 79 to 626 health facility slots & reducing low income clinic funding, and cut ADAP’s formulary. Medicaid’s caseload is up 200,00 since 2001, but he & the old legislature (D) passed a hospital tax to raise $600 million for Medicaid, CHIP & the state indigent health program; boost hospital rates & uncom-pensated care funding; and cover 100,000 more persons by raising all adult levels to 100% (now in effect for parents & by 2012 for the childless, even if not disabled) with newly-offered US health reform matching; applied the mini-COBRA law to small firms; raised CHIP’s level from 205 to 250% & widened its psychiatric care; covered the working disabled below 450%, began a SPAP for HIV clients; covered legal aliens; set a 300% level for nursing home & HCB waiver care (with no cap on patient numbers, and with related “CAHI” [www.coahi.org] & self-directed personal aide programs). Yet some parents & advocates for disabled children say the state 300% level is too low for the FOA coverage option (which US law says can be up to 500%; but US law does cap Katie Becket & HCB waivers at 300%), to reach enough such children; that their Mediicaid premiums are too high & that the state still rations how many cases can be covered The state let HMOs sell cheap policies to the uninsured--but did cut funds for DD & disabled clients’ employment, transportation & personal aide pay & may have to start an ADAP waiting list. Incoming Gov. Hickenlooper (D) favors health coverage expansion, but there’s a narrow (by 1 vote) GOP House that  may well oppose expansion.

Connecticut—is a 209(b) state with 2-zone aged/disabled levels ($786.22 & $894.61, its SSI/SSP rates for those with the highest allowed shelter costs, including the value of a $278 disregard). Its parent level is 185%/191% if wkg;  ADAP’s  is 400%; CHIP’s is 300%; and its risk pool has a low income premium discount for those under 200% & a Medicare supple-ment. Gov. Rell (R) ended the SPAP’s coverage of Pt D non-formulary Rx’s (but it still covers Pt D-excluded Rx’s); the SPAP co-pay remains $16.25 & it has no asset test (income levels are $25,100 for 1 & $33,800 for 2). She limited adult chiropractor, naturopath, psychologist and occu, phys & speech therapy coverage to clinics; but extended hospice care to all Medicaid patients. She moved to cut HIV services $2.7 million, delay starting an HIV HCB waiver, raise CHIP & Medicaid cost-sharing and drop most adult dental, eyeglass, OTC Rx &, legal alien coverage. The legislature (D) covered the wkg disabled. Rell wanted to force patients back into HMOs to fund her skimpy, subsidized insurance plan for those under 300%. With premiums up 72% since 1/10, it has big co-pays, limited psychiatric care, low Rx & medical equip cost caps/yr, a $100,000/yr total care cap & a $1 million lifetime cap--and may have to close enrollment. The state got CMS to agree to new US matching to widen Medicaid to childless non-disabled adults under 56% who were eligible for state Gen-eral Medical Assistance (even keeping its $150/mo earnings disregard), extended COBRA coverage to 30 mos, has no MSP asset tests and raised QMB’s income level to 207%+, SLMB’s to 227%+ & QI’s to 242%+ (giving most SPAP cli-ents full Pt D Extra Help too). The 2011 deficit is $263 million. Incoming Gov. Malloy (D) favors health expasnsion.

Delaware---has no spend down; covers all adults under 100% (121% for wkg parents & 110% for wkg childless, non-dis-abled adults); the ADAP level is 500% and those for CHIP & the SPAP are 200%. Gov Markell & the legislature (both D) operate a state-funded cancer assistance program for those under 650% & state-funded medical assistance (more limited than Medicaid) for others under 200%, covered the working disabled and may let over-income children buy into CHIP. 

District of Columbia---has income levels of 200%/207% wkg for parents, 100% for aged & disabled, 300% for CHIP & 400% for ADAP. A local DC managed care program covers others under 200%/211% wkg. Outgoing Mayor Fenty & the Council (both D) covered adult dentistry; boosted the aged/disabled asset level $2,000, raised QMB’s income level to 300%  & dropped its asset test (entitling many DC Medicare patients to Pt D’s full Extra Help). He proposed replacing public mental health clinic care with private contractor services & cutting funds for low income clinics and slashed DC’s just-raised MD fees & cut home care funding. DC is expanding Medicaid to childless, non-disabled adults who’ve been on non-federal medical assistance with now-available US health reform matching & is keeping the safety net, debt-ridden United Med Ctr (formerly Greater SE Hosp) open after buying it at public auction. CMS says DC --now facing a $300+ million 2 yr deficit—owes $58 million for over-claimed matching in 2004-05, which incoming Mayor Gray (D) contests 

Florida---The legislature (R) got a waiver to move patients (a court order does let them opt out) into contract managed care; but the state has so far done so in only 5 counties & a state request to extend the waiver is now being questioned by CMS, especially--since it still hasn’t been expanded to more counties, much less statewide.Yet GOP legislators & Gov-elect Scott (R) still want to expand managed care & also cut MD fees to realize savings.The under-funded, usually-closed risk pool has a Medicare supplement but no low income premium discount. The legislature cut the aged/disabled level from 88% to the $674/mo SSI rate, but covers those under 88% in HCB care or in Medicare’s 2 yr disabled waiting per-iod. The parent level is 21%/53% wkg (‘10) & ADAP’s 400% income level was cut to 300%. The state covers dentures (but little other adult dentistry) & hearing aids. Outgoing Gov. Crist (I) dropped Zyprexa & Invesa Sustena from the for-mulary, favors letting children over its 200% level buy into CHIP & made private plans cover autism care, gutted the in-surance minimum benefits law & offers cheap barebones policies for the uninsured (see www.coverfloridahealthcare.com; start-up is delayed to 12/10 or later & its policies may not meet US health reform insurance rules unless its gets an HHS waiver). Blue Cross & a local health dept. sponsor cheap ($105/mo for 1 person under 250%), barebones “Miami-Dade Blue” policies with no Rx brand coverage. Crist dropped hospice & cut dialysis care; and slashed mental health & substance abuse funds & MD fees. HCB  & home care waiting lists are long, but to settle a suit the state is spending $27 million more on HCB waivers. Crist  restored $22 million for care of the aged, disabled & special need children and men-tal health & substance abuse care; raised cigarette taxes $1 to yield $1 billion (much for Medicaid), vetoed nursing home & DD care fee cuts; and signed a bill to make insurers sell Medigap policies almost as fairly to the disabled as to the aged. Miami’s Jackson Mem Hosp is closing 2 O/P clinics & 2 transplant units; ending dial-ysis care for 175 indigents (many of them illegal aliens); and may close its North satellite branch. ADAP cut its formulary & has a waiting list of 2,246--to which 350+ more will be added by the income level cut from 400% to 300%. The HIV insurance premium assistance pro-gram level is still 400% (neither it nor ADAP have asset tests) yet is short $1.5 million even after getting $1 million from other HIV accounts--and has its own waiting list of 260+. Funding shortfalls forced Jacksonville to close 3 public clinics 

Georgia---Its aged/disabled level is only $674/mo (the SSI rate), its parent level is 28%/50% if working (‘10), ADAP’s is 300% & CHIP’s is 235%. It has a monthly numerical limit on Rx’s; dropped CHIP coverage of dental surgery & raised its premiums; ended adult emergency dentistry & artificial limb benefits and nursing home spend downs and narrowed Katie Beckett waiver admission rules. Outgoing Gov. Perdue & the legislature (both R) herded patients into HMOs, but allow opt outs. Provider fees are too low. Atlanta’s Grady Hosp, once short $40+ million due to indigent care costs, closed its dialysis center but arranged continued care for 38 indigent illegal alien patients) & 3 of its 9 O/P clinics and cut its free care level from 250 to 125%. With 2011’s $506 million Medicaid shortfall, Perdue dropped plans for provider fee raises & may cut ADAP $1.2 million. He planned to sign a 1.45% hospital bed tax (proceeds would attract more US funds to raise hos-ital fees), but MD & DDS fees will still be cut (again). He seeks insurance taxes & fines to meet health costs, closed a mental hospital building, raised CHIP premiums, cut pregnancy & infant care funds; cut welare staffing, has an ADAP waiting list of 751 & may privatize some mental health care. Incoming Gov Deal (R) favors even more health cuts.

Guam—this territory’s matching funds are capped by law far below what states get. Its local medically indigent program (MIP) pays even less than Medicaid & has almost no private providers. Scanty funding for off-island specialty care & air transport to it runs out quickly. Provider fees are too low & paid too late. Only 1 dentist takes Medicaid & CHIP patients 

Hawaii—this 209(b) state givbes limited Medicaid benefits to all adults below 200% (even the childless & non-disabled), but only parents and the aged & disabled under 100% get full Medicaid. ADAP’s level is 400%. The state covers the wkg disabled. Outgoing Gov. Lingle (R) & the legislature (D) raised CHIP’s level to 300%, ended its premiums & let richer children buy in. With an $86 million 2011 shortfall, she closed ADAP to those with CD4 counts over 350, began moving 37,000 aged & disabled into managed care, ended non-emergency adult dentistry & abegan planning unspecified benefit eliminations & reductions for non-pregnant, non-disabled adults. Incoming Gov Abercrombie (D) favors health expansion. 

Idaho---a Title XVI state, with no spend down, an aged/disabled level of $707 (the SSI/SSP rate), a parent level of 21%/ 27% if wkg (‘10) & a 200% ADAP level. The legislature (R) raised the CHIP level from 150 to 185%; funds a pilot plan for workers under 185% in participating small firms, covered the wkg disabled & sorted clients into 3 groups: Parents & children; disabled & chronic cases; and the aged. Each may get differing benefits or more co-pays but also more preven-tive care. Gov. Otter (R) covered adult dentistry but charges 4% of income premiums to Katie Becket cases. The 2011 de-ficit is $86 million, so the state may charge all disabled children extra premiums, did cut hospital, MD, rehab facility & DD agency fees (which a court then voided); slashed occu & speech therapy, mental health & autism care funding, may well cap ADAP enrollment, cut welfare staffing, closed some welfare offices, and cut or ended welfare grants foir 1,250 aged & disabled clients..The House voted to end the adult cystic fibrosis program & drop non-emergency transportation 

Illinois---this 209(b) state’s aged/disabled level is 100% (with a $25, not just a $20, disregard). Its main SPAP excludes those disabled not yet on Medicare, who get only a limited formulary from a 2^nd SPAP. Both SPAPs’ income levels are the same: $27,600 for 1, $36,635 for 2, etc. The legislature (D) raised the parent level to 185%, accepted a court order to raise pediatric fees (yet other fees are too low & paid very late, with a $4 billion unpaid claims backlog), subsidizes insurance for veterans left uncovered by VA cuts & raised CHIP’s 200% level to 300%. The often-closed risk pool has a Medicare supplement but no low income premium discount (although the new, separate US health reform-funded IL risk pool’s pre-miums are reported to be as low as $200/mo). The state is forcing 40,000 aged & disabled into HMOs but raised the work-ing disabled level to 350% & required that Medigap policies be sold as fairly to the disabled as to the aged. The U of Chi-cago Med Ctr closed its women’s & dental clinics & the U of IL at Chicago closed a clinic too. The state gave $640 mil-lion to safety net hospitals, made hospitals give the uninsured discounts & imposed a hospital “assessment fee” to raise e-nough to attract $450 million more in US matching. With a $13+ billion deficit, the legislature gave Gov. Quinn (D) auth-ority to cut the budget ($500 million in health & welfare cuts—including in community mental health--are expected). He hopes to save $400 million more with case management for the aged & disabled (38,000 of them are now on HCB waiting lists) & funded ADAP enough to serve 4,500 more clients in 2010, but its 500% income level may have to be cut to 350% .

Indiana---this 209(b) state’s SPAP for those under 150% excludes the disabled & has a much-stricter-than-SSI “209(b)” Medicaid disability rule (one must be fatally or incurably ill). The aged/disabled level is $674 (the SSI rate) & the regular Medicaid parent level is 19%/25% wkg (‘10). Gov. Daniels (R) & the old all GOP legislature raised CHIP pre-miums The risk pool has a Medicare supplement & a low income premium discount. The ACLU sued to void a once-each-6-yrs dent-ure replacement & re-lining limit. The House (briefly D, but now R again) opposed Daniels’ troubled, now-canceled eligi-bility privatization contract, while a class action suit sought to counter contractor eligibility failings. The ADAP (with a 300% level) may have to start a waiting list and 21,000+ DD clients are already on a HCB waiver waiting list. The state raised CHIP’s level from 200 to 300%. A waiver subsidizes coverage for parents below 200%--and even has up to 42,000 slots for the childless, non-disabled under 65 (but 52,000+ of them were still on a waiting list when Daniels closed enroll-ment). Although Daniels’ opposed the federal health reform bill, he now seeks to extend the waiver & then also use new-ly-available US health reform matching to implement required coverage of all non-aged adults under 133% by—or even before--2014. The coverage is through HMOs and offers preventive care, few co-pays; yet no dental or vision care —and patients must put 2%-4% of income into HSAs, pay too-costly premiums & meet $1100+/yr in cost-sharing. See “Healthy IN..” at www.kff.org. Daniel’s plans to cut provider fees 5%. The state Supreme Ct  rejected an ACLU class action suit to make the state more proactively consider other possible impairments in Medicaid disability eligibility determinations.  

Iowa--A waiver covers both I/P & O/P care and Rx’s—at first, it could only be at 2 safety net hospitals in Des Moines & Iowa City---for non-Medicare adults (even if childless & non-disabled) under 200%/250% if working,. But the state later got CMS approval to expand the waiver to let patients get care at any low income clinic in the state and (at least) emer-gency care at any hospital in Iowa. The aged/disabled level is $674/mo (the SSI rate), the parent level is 28%/ 83% if working (‘10) & ADAP’s  is 200%. The risk pool has a Medicare supplement but no low income premium discount. Med-caid faces a $600 million shortfall. Outgoing Gov. Culver & the old legislature (both D) covered disabled children under 300% via the FOA, raised the CHIP level from 200 to 300% & let children without dental coverage buy into CHIP dental benefits. The hospitals are proposing a plan to tax themselves $40 million to attract added US matching funds to raise their rates and fund other rising Medicaid costs. ADAP program costs were capped on 9/15 & there’s a waiting list of 39. Incoming Gov Branstad & the new House majority (both R) may favor Medicaid cuts, but the Senate remains Democratic 

Kansas---this Title XVI state has an aged/disabled level of $674/mo (the SSI rate), a parent level of 26%/32% wkg (‘10), a 200% CHIP level & a 300% ADAP level. Its GOP legislature, covered the wkg disabled, offered state mini-COBRA rights, raised CHIP’s level to 250%--but wouldn’t fund previously-authorized adult eligibility expansions, an adequate eli-gibility staff budget or the additional workers needed to cut a backlog of 12,000 applications. There are 5,700 on waiting lists for services for phys disabled & DD clients, yet it cut home care funding for the aged & disabled; put 6,000 more on waiting lists for HCB & home care; cut MD fees & pay for disabled clients’ caregivers by 10%, ended welfare for 1,500 awaiting SSA disability awards; denied dental care to poor women; raised CHIP premiums $10 to $20/mo; and froze ad-mission to 3 overcrowded state mental hospitals. With a $41 million 2011 Medicaid & human services shortfall, outgoing Gov. Parkinson (D) sought to have case managers oversee psychiatric Rx therapy & proposed a 1 cent sales tax raise--while the hospitals favor a tobacco tax boost & the nursing homes offered to tax themselves, with each of those 2 taxes’ proceeds to then be used to attract more US matching to raise both those providers’ respective rates The 3 taxes, if passed, could prevent more cuts from being considered--such as imposing more pre-authorization barriers, co-pays for medically unnecessary ER visits & cutting state DD facility admissions. Incoming Gov Brownback (R) favors even more health cuts 

Kentucky--- has an aged/disabled level of $674/mo (the SSI rate), a parent level of 36%/62% if working (‘10), a 200% CHIP level & a 300% ADAP level. The legislature (R Sen.; D House) dropped tough, yet unworkable, nursing home & HCB medical admission rules; capped Rx’s at 4/mo, limited occu, phys & speech therapy, x-rays & MRIs; raised co-pays; and divided Medicaid’s patients into 4 groups that can get different benefits: healthy adults; children; aged & disabled; and MR & DD patients. Gov. Brashear (D) faces an impending Medicaid/CHIP shortfall of $470 to $500 million. He says he’ll save $108 million in 2010-11 with more efficiencies & an anti-smoking benefit, and named a Medicaid Cost Control committee to offer solutions--which turned ouit to be banal & unoriginal, with few useful patient protections He enrolled 22,000 more children in CHIP & dropped its $20/mo premium. By 9/10 ADAP was able to cover the 227 patients on its waiting list us-ing several other funding sources & making economies, but the co-pays & formulary cuts are still in place . 

Louisiana---has an aged/disabled level of $674/mo (the SSI rate), a parent level of 11%/25% wkg (‘10) & a 300% ADAP level. The legislature (newly R-House; D-Sen) voted to raise the CHIP 250% level to 300% but can’t afford to. Gov. Jin-dal (R) covered the wkg disabled, got CMS to agree to a state refund of only $266 million for past overpayments; when a $30 million /yr US primary clinic grant wasn’t renewed, he found other funds to continue it; and CMS even let the state spend $97.3 million in US Medicaid hospital funds on primary care clinics. The state plans to cut $268 million by rcutting covered Rx’s from 8 to 5 /mo (unless more are “medically justified”) and slashing MD & hospital rates and funds for--and privatizing--community services & HCB waiver care for aged, CMI, DD & physically disabled clients. Jindal delayed & may drop plans to move patients into capitated PPOs & HMOs, which providers & advocates oppose. US matching falls $700 million in 2011, 2012’s deficit is $1.5 billion & he plans a $50 million+ cut in next year’s Medicaid budget. FEMA will pay $478 million to rebuild the N. O. Charity Hosp, & the state will add $300 million. But it also must find $70-$100 million/yr more for operating costs—although it even lacks enough funds to run 4 to 6 LSU & Charity Hospitals. ADAP’s  $11.7 million shortfall required shifting $2 million from other HIV accounts to it---but there’s still a waiting list of 435..  

Maine---Outgoibg Gov. Baldacci & the old legislature (both D) set these income levels: subsidized insurance, 300% (up to $8 million more in premium subsidies are now available even for part-timers); the aged & disabled, 100% (with a $75, not just a $20, disregard for both Medicaid & the MSPs); childless, non-disabled adults, 100% (a waiver that’s now taking up to 2,000 new patients); parents, 200%/206% wkg; ADAP, 500%; CHIP, 200%; the SPAP, $1,604/mo for 1 & $2,159/ mo for 2; and 250% for O/P-only waiver care for HIV+ (even “pre-disabled”) patients. There’s no risk pool. Baldacci fav-ored an employer play or pay rule, reforming hospital funding & reinsurance plans. Adult get dentures but little other den-tistry. There are no MSP asset tests & QMB’s income level is 150%, SLMB’s is 170% & QI’s is 185%. With a $100 mil-lion 2011 deficit, he raised cost-sharing for those over 150%, cut podiatry care & provider fees & may have to start an ADAP waiting list. Incoming Gov LePage (R) & the newly-elected legislature (both Houses are now R) favor health cuts.  

Maryland---has an aged/disabled level of only $674/mo (the SSI rate), a 300% CHIP level & a 500% ADAP level. An appeals court upheld an AARP/Legal Aid suit to widen the state’s too-strict nursing home, HCB waiver & at-home care medical qualification & appeal rules. A waiver merged the main SPAP & a state low income O/P clinic program into one O/P-only primary clinic care & Rx program for any & all non-Medicare adults (even the childless & non-disabled) under 116%. A state-sponsored, Blue Cross-run 2^nd SPAP (with a 300% level) covers some Pt D donut hole & premium costs, but seems to exclude the disabled. A child’s untreated tooth infection killed him, so UnitedHealth funded an indigent child treatment clinic at the state dental school. The risk pool has low income premium discounts for those under 200%, but no Medicare supplement. Gov. O’Malley & the legislature (both D) covered the working disabled, raised the parent income level to 116% for full Medicaid & subsidize insurance for some low paid small firm workers. He cut Medicaid by $82+ million, including nursing home, home health aide, private RN & HMO fees & slashed hospital rates to 80% of private plans’. A $389 million 2011 deficit at first forced him to delay a 2^nd expansion of full Medicaid to childless, non-disabled adults under 116%--but he later said he will now implement that using newly-available US health reform matching funds. He made more cuts in provider fees, HMOs, HCB programs & personal aides for the disabled & plans even more, includ-ing closing a mental hospital. He & the nursing homes hope to more than make up a fee cut with later rate increases to be funded by a 2% tax they’ll pay that will attract more US Medicaid matching. He is raising child dental fees; is carving child dental care out of HMO contracts for direct state managing & made hospitals give free care to those under 150%.  

Massachusetts---Ex-Gov. Romney (R) & the legislature (D) expanded Medicaid; required everyone to have insurance; subsidized it for those under 300%; boosted the CHIP level from 200 to 400%; raised the parent & childless disabled Medicaid levels to 133% but kept the childless aged level at only 100%. The ADAP level is 488% & the SPAP’s is 188% (but up to 500% for Pt D patients). Gov. Patrick (D), with a $2.5 billion 2012 deficit, raised subsidized insurance, Medi-caid & SPAP cost-sharing; proposed freezing MD & hospital fees; cut funds for substance abuse, tobacco cessation, school RNs & birth control; restricted legal aliens to limited I/P hospital care & a contract PPO network (advocates say it has too few providers); and proposed confining adult denture & root canal services to community health centers; raising MD & Rx co-pays (even for generics); requiring prior approval of costly psychiatric Rx’s; ending personal aide care for those getting it under 15 hrs/wk; cutting hospital fees & covered inpatient days to 20; and requiring college students to be insured. He seeks $331 million in US funds to prop up 7 safety net hospitals; Cambridge Hosp & Boston Med Ctr each  seek $90 million in state or US funds for budget shortfalls; and executives of St. Elizabeth & Carney hospitals are seeking equity buyers/partners to deal with their shortfalls). The legislature is considering forcing aged dual eligibles into HMOs. 

Michigan---has an aged/disabled level of 100%, a parent level of 37%/64% wkg (‘10), a CHIP level of 200% & a 450% ADAP level. It ended adult dental (after an untreated tooth infection killed a patient, a suit was filed to bar the cut), vision, hearing aid, podiatry & chiropractic coverage & briefly closed--but has just re-opened--its O/P care-only waiver for child-less, non-disabled adults under 35%/45% wkg. The legislature raised co-pays but boosted child wellness, dental & adult preventive fees. The Flint, Lansing, Muskegon & Detroit-area counties offer coverage to those under 200% & Oakland Co. may do so too. With a $480 million 2011-12 deficit & a ½ million more cases in 2009, the House (briefly D, but now R again) & Senate (still R) later briefly ended adult vision care--and must make more cuts, or raise taxes, in 2011-12. The legislature sent outgoing Gov Granholm (D) a budget restoring adult dental, vision & podiatry (but not hearing aid or chir-opractic) services; avoids MD, hospital & mental health cuts (the latter was cut only $1 million) Advocates are demanding & may sue to get more autism coverage in Medicaid & private plans.Incoming Gov Snyder’s (R) plans aren’t yet detailed.  

Minnesota---this 209(b) state has an aged/disabled level of 100%, a regular, full Medicaid parent level of 215%/ 219% if working (‘10), a CHIP level of 275%, an ADAP level of 300% & a risk pool with low income premium discounts for those under 200% & a Medicare supplement. With a projected $6 billion 2011-12 deficit, Gov. Pawlenty (R) raised premiums & co-pays for Medicaid, CHIP & Minnesota Care (Medicaid waiver-funded, subsidized insurance for parents under 275% & childless, non-disabled adults below 250%) and denied Medicaid & CHIP to legal aliens. He ended ADAP co-pays, covered the working disabled, yet capped enrollment in HCB care. He tightened medical qualifications for--and cut paid hours of--home aides; reduced nursing home & HCB waiver care fees; raised some client premiums; ended cov-erage of occu & speech therapy and audiology; and dropped adult dentistry. He & the legislature (then-D) compromised to preserve a cheaper, barebones state Gen Med Asst (GMA) program for childless, at least partially disabled adults under 75% with stingy block grants totaling under ½ of GMA’s earlier budget for provider hospitals to treat them. Hennepin Co. Med. Ctr can’t keep giving free care to other counties’ indigents & had to cut dental, mental health & HIV services. At first, no non-Twin Cities hospitals became providers in the new GMA plan because the grants are far below the cost of care. Pawlenty & the outgoing egislature (D) compromised again to authorize his successor, Gov-elect Dayton (D), to expand US-matched Medicaid to also cover GMA patients, as now allowed by the US health reform law  (but the newly-elected GOP legislature opposes health expansions). Pawlenty had also tried to boost the appeal of the new, low GMA grants to the hospitals--yet convinced only Hennepin & 3 others, but none outside the Twin Cities--by putting ceilings on the number of GMA patients each must take. Yet 18,000+ non-Twin Cities GMA patients now have no regular providers--and even those going to those 4 Twin Cities hospitals face long waits for primary care & even longer waits for specialists .   

Mississippi---has no spend down. Gov. Barbour (R) cut the aged/disabled level from $1,000+ to $724/mo (with a $50, not just $20,disregard) and there are no MSP asset tests. The parent level is 24%/ 44% wkg (‘10), CHIP’s is 200% & ADAP’s is 400% (which may be cut to 200%). Only 2 brand Rx’s & 3 generics/mo are covered (HIV patients get 5 brand Rx’s). Barbour cut phys, speech & occu therapy benefits & an in-person re-application rule limits enrollment; he & the Senate (nominally D) won’t drop it, except maybe for LTC, but the House (also nominally D) might. After securing new cigarette & hospital taxes, Barbour first dropped, then again proposed MD, DDS, Rx, nursing home & hospital fee cuts, as well as patient premiums & higher co-pays; cut mental health center subsidies, proposed closing 4 mental hospitals & 15 mental crisis centers and opposes using state reserve funds & even enhanced US matching funds to bolster Medicaid (it is short $34 million). Some disabled children’s parents say the state has tightened Katie Becket waiver medical qualification rules . 

Missouri---is a 209(b) state. Its risk pool has no Medicare supplement but has a low income premium discount (and the pool director has called for even more affordable premiums). The GOP legislature cut the aged/disabled level from 100 to 85%; ended medical assistance for those awaiting SSA disability awards; cut the parent level to 19%/ 25% if wkg (‘10); ended adult dental coverage; raised CHIP premiums; denied CHIP to those whose job plans cost under 5% of income (with exceptions); raised & more strictly enforced co-pays; but kept the ADAP & CHIP levels at 300% & raised the SPAP (which covers those disabled on Medicare) level to 150%. Blue Cross & a foundation subsidize insurance for KC-area families under $30,000. The state uses “premium support” to pay clients’ job plan premiums rather than give them full secondary Medicaid; restored hospice & working disabled coverage (but the latter covers only those with very low SSDI awards); gave birth control & screenings to women under 185%; restored adult vision (except for the aged in nursing homes), hearing aid & podiatry benefits; and let the aged & disabled opt out of HMOs. A court made the state widen notice & hearing rights before CHIP terminations; and the state lets clinics enroll children. Gov. Nixon (D) asked the still-GOP legislature to partially restore the former 100% parent level (only to 50%, but it refused even that); cover all adult dental, hearing & vision care (also rejected); and liberalize CHIP premiums & coverage (killed too). A caseload grown by 40,000+ since 1/09 forced Nixon to drop plans to restore the 100% aged/disabled level & do more enrollment outreach (in fact, new red tape instead now impedes enrollment). He sought cuts of $139 million in hospital rates & $32 million in MD & DDS fees and in mental health & public clinic funding; and did cut the ADAP formulary. The legislature made private plans cover some autism care. CMS said the state home health benefit is improperly limited only to homebound patients. 

Montana---has an aged/disabled level of $674/mo (the SSI rate), a parent level of 32%/56% if wkg (‘10), an ADAP level of 330% & a risk pool with low income premium discounts for those under 150% & a Medicare supplement. The 2011 deficit is $201 million, so the state raised cost-sharing and cut LTC & hospice benefits and access—and also limited aged & disabled MD visits to 10/yr. But Gov Schweitzer (D) & the legislature (with both Houses now R) ended a CHIP waiting list (yet ADAP has one of 13); seek a waiver to cover more adults; raised the family asset level; set up a SPAP for Medic-are patients under 200%; widened CHIP dental & preventive care; and made private plans offer vaccinations & well-child care to age 7. A referendum raised the CHIP level (a 2^nd time) to 250% but the children’s enrollment pace has slowed.

Nebraska---is a Title XVI state with a one-house “non-partisan”, but conservative, legislature. Its aged/disabled level is 100%, its parent le-vel is 47%/58% if wkg (‘10) & ADAP’s is 200%. It ended Medicaid for many parents who chose to leave welfare to  work, yet the state Supreme Ct forbade denying Medicaid to those who fail to meet work mandates. The risk pool has a Medicare supplement but no low income premium discount. Gov Heineman (R) covered Pt. D co-pays for HCB & group home clients & raised CHIP’s 185% level to 200%. With a $340 million 2012 deficit, the latest budget cuts non-primary care Medicaid & CHIP reimbursement by $68+ million & the state may limit dental care to $1,000/yr, hear-ing aids to 1 per 4 yrs, eyeglasses to 1 per 2 yrs & adults to 12 chiropractic visits & 60 occu, speech & phys therapy ses-sions/yr. The ADAP formulary was cut. When the state Medicaid program stopped covering pregnant aliens (even legal ones), over 1,500 births went untreated, were premarure or stillborn—even though the U of NE Med Ctr icovered them in its own indigent program—so the legislature’s now reconsiering the cut  The state widened school-based health services. 

Nevada---a Title XVI state with no spend down; its disabled level is $674/mo (the SSI rate), but the aged-only level is $710.40 (their higher SSI/SSP rate); its parent level is 25%/88% wkg (‘10); its CHIP level is 200%; its ADAP level is 400%. It subsidizes insurance for parents under 200% working in participating small firms and covers the wkg disabled. Its SPAP, with a 225% level, covers the disabled & even offers a vision benefit; but the state raised CHIP premiums With an $8.5 billion 2011 deficit the legislature (D) capped CHIP dentistry at $600/yr; ended Medicaid adult dental & vision benefits, CHIP orthodontia; tightened SNF, ICF, HCB waiver & home care medical qualification rules; and cut pregnancy coverage, hospital rates (closing the U of NV.at LV Hosp’s dialysis & oncology clinics), HCB waiver fees & attendant funds for the disabled; non-emergency transport, hospital neonatal, HCB & pediatric specialist fees. The LV-area HIV budget was cut $1 million & the many new indigents at low income clinics are causing big budget shortfalls. The state set up a formulary of anti-psychotic, anticonvulsant & diabetic Rx’s. Incoming Gov Sandoval ‘s (R) health plans are unclear. 

New Hampshire---a 209(b) state; its a risk pool has no Medicare supplement but has low income premium discounts for those under 250%. Its aged/disabled level is $714 (the SSI/SSP rate, but the disregard is just $13, not $20/mo). The parent level is 39%/49% wkg (‘10), and the CHIP & ADAP levels are 300%. The state has a much-stricter-than-SSI “209(b)” Medicaid disability rule (inability to work for over 4 years) & doesn’t cover hospices. Gov. Lynch (D) & the legislature(now R again) shifted LTC costs to counties, ended a DD care waiting list & let 19-to-26-yr-olds buy into CHIP--and will make more cuts in hospital, MD, LTC & mental health fees (before the cuts, 2011’s deficit was projected at $75 million). US auditors want $35 million in over-claimed DSH funds back & 2010 Medicaid costs ran $43 million over budget . 

New Jersey---has an aged/disabled level of 100%; a 500% ADAP level that Gov. Christie (R) curtailed by limiting the  formulary for those over 300%and SPAP levels of $31,850 for 1 & $36,791 for 2. A waiver covers others (even childless & non-disabled adults) under 100%. The legislature (still D) raised the parent level to 200%, boosted MD fees & low in-come clinic funding & ended CHIP premiums for those under 200%, But Christie later proposed to (and may even did) lower the parent level to 133%. One audit questioned $52 million in school health costs & a 2nd said hospital indigency prog-rams fail to collect millions from other liable payers. A trial court barred an assisted living facility chain from refus-ing to let remain using Medicaid when their own funds run out--but after some facilities tried to evade the order (which was upheld on appeal) by giving up their Medicaid provider licenses, the legislature is about to pass a bill requiring them to set up escrow funds to pay for continued care of such residents--even if a facility closes down or goes bankrupt. With an $11 billion 2011-12 deficit, The state cut hospital charity & teaching, day health center & the SPAP & ADAP formu-laries & raised SPAP co-pays. Christie seeks to drop adult aliens (even if legal) & township indigent care funding & close parent enrollment, but the legislature (still D) made him drop plans to again raise SPAP co-pays & impose $310/yr deductibles--yet he’s still refusing US funding for female birth control, obstetrics &  even for cervical & breast cancer screening. 

New Mexico—has no spend down, but has a risk pool with a Medicare supplement & low income premium discounts for those under 400%. Its aged/disabled level is only $674/mo (the SSI rate), its parent level is 29%/67% if wkg (‘10), CHIP’s is 235% & ADAP’s is 400%. A waiver—which is again closed to new individual applicants, but not to small employer groups---heavily subsidizes insurance of any adult (even if childless or non-disabled) under 200%/250% if wkg. The state still refuses to process disability-based Medicaid-only applications from those whose disability hasn’t yet been approved by SSA---contrary to what’s long been a federal requirement---no matter how much they need medical care). Medicaid’s shortfall may be $300 million by 1/11 (it’s $40 million now), so outgoing Gov. Richardson (D) & the legislature (still D) dropped eligibility expansion plans;  may end adult dental, vision, hearing aid & hospice coverage; did slash phys, occu & speech therapy; cut mental health and substance abuse benefits & fees; and may even cut or drop Rx coverage and HCB waiver services. Gov-elect Martinez’ (R) expected health cuts are expected to be even deeper. 

New York---has a waiver for parents & couples (even if childless) under 150%, and childless (even non-disabled) single adults under 65 below 100% (but the level’s only $767/mo for childless aged). ADAP’s level is 431%. The state subsid-zes insurance for workers under 250%, but caps Rx’s at $3,000/yr. The legislature (D House; with Senate control still not yet clear) excludes the disabled from the SPAP (it has a 350%+ level); won’t cover digital mammograms; raised Rx & MD co-pays (but caps them at $200/yr); adopted a loose formulary; covers assisted living, chore aide & adult day care; its counties pay ½ of state Medicaid costs (but their increases are capped at 3.5%/yr); lets providers deny services to those who don’t meet co-pays; funded HIV day health care; covered colon & prostate cancer patients & wkg disabled below 250%; required hospital discounts for those under 300% & banned taking debtors’ homes; passed mental health parity; & raised CHIP’s level from 250 to 400%. With a $1 billion+ 2011 deficit, Gov. Paterson (D) made a $1 billion hospital & nursing home fee cut; started a discount Rx plan for near-poor disabled; raised all Medicaid asset levels ($13,050 for 1, $19,200 for 2, etc); ended MSP & SPAP asset tests; extended COBRA to 36 mos; proposed raising all adult levels to 200%; but sought to cut Medicaid & mental health $471 million more, force NYC HIV patients & all dual-eligibles into HMOs, proposed a $65 million group home cut (yet a US judge then ordered that 4,300 mentally ill be moved into small-er, better facilities) and signed a bill with $775 million in health cuts that requires saving $300 million more in each com-ing year, pares $72 million from low income health programs; and makes big hospital fee cuts. Short $316 million, NYC’s public hospitals plan to cut child mental health & Rx benefits and close some clinics. NYC also proposed to end its school dental program & cut its HIV services $17 million. The NYC Council de-funded a health insurance advocacy program & its safety net St. Vincent Hosp closed. Paterson had earlier proposed cutting NYC public hospital subsidies $370 mil-lion & Mayor Bloomberg proposes cutting up to 182 school nurse jobs. Gov-elect Cuomo’s (D) health plans are still unclear. 

North Carolina---covers the wkg disabled, but allows only 8 Rx’s a month (plus another 3 or more on an exception bas-is).Its aged/disabled level is 100%; its parent level is 36%/49% if wkg (‘10) & its CHIP level is 200% (the deficit now  prevents raising it). The SPAP– which excluded the disabled & ceased operating in 3/10, but may be re-started after 1/11 —subsidized Pt. D premiums for those under 175% not on full Extra Help. The legislature (D through 2010, but R begin-ing in 2011) created a ^nd SPAP for ADAP clients on Medicare under 175% but ineligible for Pt D full Extra Help & passed limited mental health parity. It started a risk pool that excludes Medicare patients, requires pre-authorization & has a $250 co-pay for “specialty” Rx’s & a $100,000/yr out-of-pocket cap, but has low income premium discounts. With a $1.2 billion 2011 deficit Gov. Perdue (D) seeks $30 million in drug maker rebates by starting a preferred Rx list (she later added some psychiatric Rx’s to it); to propose closing 50 state mental hospital beds & cutting MD, hospital, personal aide (plus limiting aide care to 18hrs/ wk), adult dentistry, maternal care outreach, mental health & community mental health funding (the last by $210 million). The budget cut audiology, speech, phys & occu therapy & hospice funding and ADAP by $3 million (causing a waiting list that briefly hit 811, a formulary cut limiting coverage to Tier 1 Rx’s & a cut of ADAP’s income level from 300 to 125%). It ends a Medicaid HIV case manager program & coverage of commun-ity-based rehab care and many child dental X-rays & sealants; limits breast surgery & coverage of diabetic items to 1 pro-vider; and requires prior approval of X-rays, MRIs, MRAs, PET scans, ultrasounds & some EPSDT services. .2011’s Me-dicaid shortfall is $475 million. The state later found $14.1 million more for ADAP, cutting its waiting list to “only” 66. 

North Dakota---this 209(b) state has a risk pool with a Medicare supplement but no low income premium discount. Its aged/disabled medically needy level is $750, its parent level is 34%/59% if wkg (‘10) but the ADAP level was cut from 400 to 300%. Gov & incoming US Sen Hoeven (R) covered disabled children under 200% via the FOA, boosted the CHIP level to 150% & raised the medically needy/spend down level. But the legislature (R) refused to again raise the CHIP level (to 200% this time) and cut ADAP’s formulary, capped its costs & enrollment and limited patient access to Fuzeon. 

Ohio--this 209(b) state has a parent level of 90% and cut the ADAP level from 500 to 300% (disenrolling 257 clients, triggering a waiting list of 338 and---only after public hearings are held & other administrative rules are met---possibly denying eligibility to 861 of those with CD4 counts over 500 if their CD4 counts didn’t ever fall below 200). But then outgoing Gov. Strickland (D) shifted $12.8 million in new US Medicaid funds to ADAP to help ease--but not fully eliminate--the cuts. Ohio slashed adult dental funds 50%, secondary fees for dual eligibles & medical assistance for those awaiting SSA disability awards; moved most patients into HMOs (some with too few specialists); let providers turn away those who don’t meet co-pays; but did pass private plan mental health parity. Its aged/disabled level is still only $589/mo (the US’  lowest). Strickland & the outgoing legislature (R-Sen; D- House) raised CHIP’s 200% level to 300% (effective only when a lawsuit is decided) & covered disabled children under 500% via the FOA. He got a waiver to cover assisted living & lets over-income children buy into CHIP. He cut nursing home fees (but the legislature then partially restored the fees & bol-stered home care benefits); can’t afford to cover adult digital hearing aids until 6/11; cut Rx fees & community mental health funds; imposed Rx co-pays & a generics preference rule; delayed provider fee raises & fully restoring adult dental benefits; and told nursing homes to themselves pay for their own patients’ physical therapy, wheelchairs & medical equip (which some homes can’t or won’t cover, so some patients may not get needed care or equip). He moved 592 from wait-ing lists into HCB waiver care & signed bills imposing $718 million in fees on hospitals (with proceeds to be used to at-tract more US matching, with which to then raise rates) & extending state mini-COBRA rights to small firms. Incoming Gov. Kasich & the leaderships of the new Senate & House (all 3 now R) plan for big Medicaid budget & eligibility cuts.  

Oklahoma---this 209(b) state cut the aged/disabled level from 100% to $718 (the SSI/SSP rate). The parent level is 31%/47% wkg (‘10) & ADAP’s is 200%. It ended its parents & children spend down, originally had a 3-Rx’s/mo limit & doesn’t cover hospices. Putgoing Gov. Henry (D) covered the breast/cervical cancer & wkg disabled groups and a waiver subsidizes insurance for students, the unemployed & workers under 200% in participating small firms. Eligibility was lat-er widened & the legislature (R) cut policy premiums--but also slashed benefits. It expanded Medicaid to cover assisted li-ving; raised the CHIP level from 185 to 300%; encouraged HSAs in employer plans; and guted the insurance minimum benefits law. With a $26.6 million Medicaid cut, the state may drop pregnant women’s dentistry, durable medical equipt & nebulizors and cut dialysis, diabetic supply, hospital, MD & nursing home fees; and raised some co-pays. It seeks to limit ER visits to 3/yr; cut mental health care for 55,000 clients &  closed 200 mental hospital beds; cut covered brand Rx’s from 3 to 2/mo; ended coverage of speech, occu, & phys therapy. Incoming Gov. Fallin (R) favors more health cuts.  

Oregon---this Title XVI state’s risk pool has no Medicare supplement but has low income premium discounts for those under 185%. Income levels are $674/mo for aged & disabled (the SSI rate), a 32%/40% if wkg for parents (‘10), 185% for an insurance subsidy for non-Medicare adults (with enrollment closed) & 200% for ADAP. An anti-tax referendum cut eligibility & adult dentistry and ended adult vision care. With a $577 million 2011 deficit, the OR Health Plan expansion waiver--with limited benefits for all non-Medicare adults under 100%--again froze enrollment. ADAP has cost-sharing, with a waiting list & formulary cut also possible. Gov Kungoloski & the legislature (both then D) took the FOA option & passed insurer & hospital taxes--later upheld in a referendum that also raised taxes on the rich--to cover 80,000 more chil-dren (raising CHIP’s level to 300%) 35,000 more adults & more home care. Yet he later had to end home care for 100s of cases Incoming Gov. Kitzhaber (D) favors expanded health care but the new House is tied between the GOP & Democrats. 

Pennsylvania---has an aged/disabled level of 100%, a parent level of 26%/34% if wkg (‘10), a CHIP level of 300% & an ADAP level of 350%. It subsidizes a barebones “AdultBasic” insurance for non-Medicare adults under 208%/213% wkg (with no mental health or Rx benefits; the 390,000 on its waiting list can buy similar private coverage for $600/mo; but AdultBasic’s own increasingly costly clientele required imposition of $20 MD visit co-pays & a $1,000/yr hospital care cap). Outgoing Gov. Rendell (D) covered the working disabled, raised the SPAP’s levels (to $23,500 for 1 & $31,500 for 2, enough to cover 90,000 more aged, but it still doesn’t cover the disabled) and applied 9 month state mini-COBRA rights to small firms. But the state cut its State Supplement (SSP) to SSI by $5/mo for eac h client. Gov-elect Corbett & the incoming legislature (both Houses are now R) want more cuts (e.g., adult dentistry) oppose expansions & some want to freeze CHIP. (The outgoing House [D] had twice voted to widen AdultBasic to cover 85,000 more c;lients & add Rx & mental health benefits.) The 2011-12’s deficit is $4 billion. Phila city clinics began to charge $5-$20 a visit & close some sites. The state plans to offer $300/mo premium discounts to those under 200% in its US health reform-funded risk pool. 

Puerto Rico----its matching rate is capped far below what states get. Its ADAP income level is 200%. ADAP reviews & audits report inadequacies in care & fiscal irregularities. A key advocate has said there’s a 526-person ADAP waiting list 

Rhode Island---has these income levels: aged/disabled,100%, parents, 175%, CHIP, 250% & ADAP 400% (just cut to 200%, causing a waiting list of 12). The state covers the wkg disabled & its limited formulary SPAP covers the aged but only disabled over 55 (with levels of $37,167 for 1 & $42,476 for 2). Gov Carcieri (R) required free & discount  hospital care for those under 200% & 300% and banned taking debtors’ homes. Public Citizen says MD fees are the US’ 3^rd low-est. Big deficits ($107 million in 2011) moved him to get a waiver with extra up-front US funds; in exchange it requires the state to shift 12% of nursing home cases to cheaper home care & caps future US funds.The legislature (then & now D) raised adult daycare co-pays; dropped Medicaid for legal alien children, 7,400 parents.& ended health insurance for childcare workers Incoming Gov, Chaffee (I) is excepted to have a moderate health policy. 

South Carolina---has no spend down. Its aged/disabled level is 100% & its parent level is 48%/89% if wkg(‘10). It cut its ADAP level to 300%. Its risk pool has a Medicare supplement but no low income premium discount. Gov. Sanford & the legislature (both R) limited Rx’s to 4/mo & raised CHIP’s level to 200% (but he then proposed closing enrollment). The SPAP has a 200% level but excludes the disabled. With enrollment up 90,000 since 2007, the state cut mental health benefits, closed an HIV program to new clients & slashed home health, hospital & nursing home fees. Yet it passed private plan mental health parity & a tobacco tax increase to bolster Medicaid that Sanford then vetoed. The state eliminated SPAP coverage drugs not covered by Pt D, cut SPAP funding and ended its ADAP funding & disenreolled 200 patients (even though the waiting list is already 248), cut home, personal aide & HCB care ( the last 3 are under court challenge) & Rx coverage from 4 to 3/mo, de-funded cancer screening and incoming Gov Haley (R) wants even more Medicaid cuts.     

South Dakota---has no spend down. Its aged/disabled level is $674/mo (the SSI rate), its parent level is 52% (‘10) & ADAP’s is 300%. Rejecting a call for expansion, Gov. Rounds & the legislature (both R) refused to raise the pregnant women’s & CHIP levels to 250% or provider fees and ended adult dental coverage.    

Tennessee----Outgoing Gov. Bredeson (D) & the legislature (R) set the aged/disabled level at $674/mo (the SSI rate), the parent level at 70%/129% if wkg (‘10) & ADAP’s at 300%. Except for the pregnant, children & HIV+ patients, MD visits were cut to 10/yr, hosp days to 20/yr & Rx’s to 2 brand name drugs + 3 generics/mo, except for some grave conditions. There’s a 250% CHIP level, a risk pool (with no Medicare supplement but with a premium discount for those below 250%), a SPAP (with a waiting list & low benefits cap) covering up to 5 generics/mo for non-Medicare patients under 250% & subsidized barebones insurance for non-Medicare adults under $55,000 (enrollment is closed). CHIP uses Medicaid Rx rules, but also covers diabetic items & more psychiatric Rx’s. Home care & medical equip benefits were cut. Deficit-pre-vention budgeting forced closure of 600 mental hosp beds, big mental health cuts & a $500 million hosp rate cut—causing short-falls at Nashville Gen Hosp (which then had to deny non-emergency care to indigent illegals) & Memphis Reg Med Ctr (though the latter was then bolstered with a $30 million US/state grant). Bredeson deferred caps on MD visits, trans-port & transplant care, kept a $10,000/yr benefits cap; curtailed occup, speech & physical therapy benefits; and capped X-ray & lab usage and ADAP costs. A court voided its 1987 order grandfathering-in 150,000 ex-SSI recipients to Medicaid (almost all of whom were then found ineligible under today’s regular rules); see “Daniels Case” at www.tnjustice.org  In-coming Gov. Hasdlam (R) is expected to favor even further Medicaid cuts. 

Texas—has a risk pool with a Medicare supplement & but no low income premium discount .The aged/disabled level is  $674/mo (the SSI rate), the parent level is 12%/26% wkg (‘10) & the ADAP & CHIP levels are 200%. Gov. Perry & the legislature (both R) dropped coverage of  CHIP prostheses, physical therapy & private duty nursing; raised CHIP co-pays & premiums; cut Medicaid home health; ended adult chiropractic & podiatry care; capped the number of Rx’s covered/mo ;moved patients into HMOs; contracted-out eligibility work to what some say are sub par contractors--but restored Medic-aid mental health, vision & hearing aid coverage and CHIP mental health & dentistry (Medicaid covers limited adult den-tistry too); required some mental health parity in private plans; and set up a SPAP for HIV clients. A non-profit agency (www.TexHealthCoalition.org) fosters subsidized cheap health plans for workers under 300% in small firms in the Brazos Valley, Dallas, El Paso, Ft. Worth, Galveston & Houston. A court order to improve child health & EPSDT requires higher MD & DDS fees (but budget shortages are now forcing cuts in all provider fees). The 2011-12 deficit is $25 bilion (due in part to 350,000 added Medicaid clients in 2009-10). The legislature cut the Children with Special Health Needs program--plus a cystic fibrosis aid program for all ages--by $3.5 million (even with 950 children on a waiting list); dropped funding for 13,000 HCB waiver slots & authorized cutting the ADAP income level from 200% to 125% if financially necessary. Gov. Perry and other GOP leaders have begun publicly toying with dropping out of the Medicaid program altogether. 

Utah—is a Title XVI state with a risk pool that has a low income premium discount, but no Medicare supplement. Its aged/disabled level is now 100%, its parent level is 38%/44% if wkg (‘10) & CHIP’s is 200%. A waiver—now closed to new enrollees--gives limited O/P care, with big co-pays, to non-Medicare adults (even if childless & non-disabled) under 150%. The legislature (R) stopped covering podiatry, audiology, speech therapy, chiropractic, outdoor wheelchairs and adult eyeglasses & dentistry (one patient’s untreated tooth infection spread to her brain & killed her); cut hospital & DDS fees 25%; but subsidizes insurance for workers under 150% in participating small firms (see “New CHIP /UPP Waiver..” at www.healthpolicyproject.org) A legislative reform panel called for gutting the minimum benefits law & banning preexisting condition rules; and urging employers to offer HSAs instead of regular insurance--and the state let insurers sell even-cheaper-than-COBRA, barebones policies. Gov. Herbert (R) restored dental care for children & pregnant women and some phys & occu therapy. Yet he & the legislature cut DDS fees again (which CMS then disapproved); until recent-ly had an ADAP waiting list of 143 and cut its formulary & income level (to 250%, disenrolling 89 clients); closed enroll-ment in Gen. Asst. welfare for those awaiting SSA disability awards (which then impedes access to already-hard-to-get Gen Medical Asst). They may cut the disabled level from 100 to 74%, school health funds & the pregnant women’s asset level & drop the spend down—but are considering a $23 million hospital tax to attract $50 million more in US matching. 

Vermont—Its levels are: aged/disabled (2 zones) 101% & 110%; parents, 185%/191% if wkg; childless, non-disabled adults, 150% /160% if wkg; CHIP, 300%; ADAP, 200% & the SPAP, 175%. There are no MSP asset tests. The state sub-sidizes insurance for others under 300%. Dentures still aren’t covered & there’s a $495/yr dental care cost cap per adult patient). A waiver, in return for more US funds, moves patients into HMOs & favors HCB care over nursing homes--but also caps future US matching funds. The 2011 health & welfare shortfall is $53 million. Outgoing Gov Douglas (R) prom-ised not to cut eligibility (and even signed a bill requiring more private insurance autism coverage), yet raised SPAP co-pays & sought more client cost-sharing (but the Democratic legislature blocked higher CHIP premiums), a cap on allowed ER visits and provider & druggist fee cuts, Incoming Gov. Shumlin (D) is expected to favor health coverage expansion. 

Virginia---this 209(b) state’s parent level is 23/29% if wkg (‘10), CHIP’s is 200% & ADAP’s is 400%. It covers the wkg disabled & has a SPAP for HIV+ Pt. D patients under 300%. To cut a $4 billion deficit, Gov. McDonnell & the House (both R) ignored less stringent Senate (D) proposals to slash provider fees & mental health & substance abuse community care funding, lower the $2,200/mo HCB waiver income level to $1,685 (even with a HCB waiting list of 6,000); cut CHIP’s 200% level to 175% (which will turn away 28,000 children) and the 80%aged/disabled level to 75%. ADAP faces a $12.6 million shortfall that may limit some patients’ access to Rx’s (the state capped ADAP spending on 11/15/10).   

Virgin Islands--its matching rate is far below what states get. Some say its ADAP (with a 400% level) has a waiting list. 

Washington--its risk pool has a supplement open to some, but not all, Medicare patients & a low income premium discount for those under 300%. Its aged/disabled level is $720 (the SSI/SSP rate), its parent level is 37%/74% if wkg (‘10) but ADAP’s 300% level was cut to 275%. Gov. Gregoire & the legislature (both D) passed mental health parity. Assisted living facilities evicted over 75 clients due to low state fees. A $112.8 million health assistance budget cut forced her to drop 21,000 undocumented alien children & propose dropping 27,000 others from CHIP (its income level had only recent-y been raised from 250% to 300%). The state raised BasicHealth (its subsidized insurance for non-Medicare adults under 200%, with a waiting list of 100,000+) premiums & co-pays; cut General Medical Assistance (by $190 million, dropping 3,000+ patients), DSH payments & nursing home fees; and limited drug, DME, imaging, denture, diabetic supplies, personal aide & home care hours, adult day care, maternity & infant case management & incontinence benefits and cut druggist, pediatric MD, HMO & day health center fees. It may drop adult hearing aids, podiatry, vision care, dentistry, colorectal cancer screening and---since a referendum to impose income taxes on the very rich failed at the polls, while the voters instead even repealed some existing taxes---be forced to drop adult hospice care & Rx benefits. Yet the state may let over-inome children buy into a CHIP-like plan. ADAP’s formulary was cut, cost-sharing was imposed & Gregoire proposed a 25% cut in other HIV care. The state had once sought insurer bids to offer a low-cost insurance & has begun exploring using newly-available US health reform matching to fund the merger of the BasicHealth program into Medicaid . 

West Virginia---has an aged/disabled level of $674/mo (the SSI rate), a parent level of 17%/33% if wkg (‘10) & a 250% ADAP level. It covers only 4 brand Rx’s/mo (+6 generics). Its risk pool has no Medicare supplement but low income pre-mium discounts have been authorized. It denies all adult dental care but extractions & emergencies a& didn’t properly ad-opt nursing home & HCB medical admission rules (which still impede access). Ex-Gov Manchin & the legislature (both D) started an Rx aid plan for non-Medicare adults under 200%. CMS is trying, over state objections, to halt a waiver that offers clients more mental health care & Rx’s--but only if they sign “personal responsibility” pledges. Manchin raised the CHIP level to 250% but plans to herd the disabled into physical & mental health managed care and parents & children in-to dental & mental health managed care that advocates say cuts access to care. Gov Tomblin’s (D) health plans are unclear , 

Wisconsin---has an aged/disabled level of $757.78/mo (the SSI/SSP rate),a 300% ADAP level & a 240% SPAP (which excludes the disabled) level. The risk pool has a Medicare supplement & premium discounts for those under $33,000. Outgoing Gov Doyle & the old legislature (both D) raised the CHIP (185 to 300%) & parent (185 to 200%) levels, made private plans cover child hearing aids & cochlear implants & funded “Basic Care” (with no brand name Rx coverage) for up to 54,000 non-Medicare childless adults under 200%. To avoid a big deficit--and with health programs many millions over budget---Medicaid staff cut $600+ million from administrative, contractor & provider costs, without cutting eligibil-ity or benefits. Basic Care enrollment now exceeds funding capacity (plus 51,000 more on a waiting list or with not-yet-processed applications), so Doyle closed enrollment in it; but proposed a new, cheap, skimpier plan for those on the wait-ing list (one news story said he may seek newly-available US health reform matching to merge both Basic Care & the pro-posed  overflow plan into Medicaid). He sought a $900 million hospital tax to raise their rates by attracting more US Med-icaid matching. For 2011-12, the state needs $675 million more for medical assistance, and faces a $2.7 billion total pro-jected deficit—but incoming Gov Walker & the new legislature (both now R) aren’t expected to protect Medicaid. 

Wyoming--has no spend down, an aged/disabled level of $699 (the SSI/SSP rate), a parent level of 40%/52% if wkg (‘10) & a 200% CHIP level. Its SPAP covers non-Medicare persons below 100%. The legislature (R) widened CHIP mental health, vision & dental benefits. Gov. Freudenthal (D) added a risk pool low income premium discount for those under 250% (the pool already had a Medicare supplement). Medicaid‘s 2010 costs rose $100 million—and next year’s Medicaid budget shortfall is $192 million---so the state plans to cut most provider fees $25.6 million, the DD HCB waiver budget by $3.6 million (freezing-in a waiting list) & its dialysis program by $250,000. ADAP’s 332% income level was cut, its  were capped and it may have to again start a waiting list. Incoming Gov. Mead (R) is expected to cut Medicaid even more 

SOURCES AND RESOURCES:

For the 48 states & DC, 2010’s federal poverty level (FPL) is $10,830 yearly ($902.50/ mo) for one plus $3740 yearly ($311.67/mo) more for each add’l person; see the Asst. Secy. for Planning & Evaluation pages at www.dhhs.gov for prior years’ FPLs  and AK’s & HI’s separate & higher FPLs. The 2010 SSI rates (not including state supplementary payments, or SSPs) remain the same as 2009’s: $674/mo for 1 & $1,011 for 2. Email sherry.barber@ssa.gov for “State Asst. Programs for SSI Recipients, 1/09”(the latest available issue) on state Medicaid eligibility rules for SSI & SSP recipients, state supplementary payment (SSP) amounts and state Section 1616, 1634 & 209(b) eligibility arrangements   

Good sources for state parent & childless, non-disabled adult income levels are “Where Are States..? Med-icaid & State..Elig. . Levels For..Adults” [pub. # 7993, Tables 1-3] and  “Medicaid.. [and MSP] .. Elig... [Levels]..for the Elderly &..Disab[led] ..” [pub. # 8048, Tables 1 & 6] in the Medicaid pages at www.kff.org  

At www.kff.org see “Medicaid Expansion Now..[Can].. Save…States Money” ( 4/1/10), saying states can augment their health budgets by now being able to get regular Medicaid matching rates for previously fully state-funded medical assistance for childless, non-disabled adults under 133% FPL; and “Explaining …: Benefits & Cost-Sharing That States Can Set For [New] Medicaid Beneficiaries” (Doc. #8092 of 8/9/10). For federal policy on this, see CMS’ State Med Dir Ltr #10-005, “New Options for Coverage Under Medicaid” (4//10/10) & State Med Dir Ltr #10-013( 7/2/10) on required “Family Planning & Benchmark [plus mental health & Rx] Coverage” of new eligibles at www.cms.gov

Medicaid Coverage & Spending in Health Reform: For Adults ..Below 133%..” at www.kff.org projects the num-bers of new Medicaid patients & states’ very, very small added share of costs starting in 2014 ( 0% to 10%); “Fe-deral Government Will Pick Up Nearly All Costs…” at www.CBPP.org also confirms that permanent  90%+ match

www.kff.org/medicaidbenefits/ lists state chiropractor, podiatry, eyeglasses, optometry, hearing aid, hospice, psychologist, prosthetics, home health, medical equip, dental, Rx’s, OTC items & phys, occup & speech therapy coverage, 2003-8 

See various guides on how to block bad state plan amendments at www.healthlaw.org. and http://www.nachc.com .    

The “National ADAP Monitoring Report, 2009” at www.kff.org , lists state income & asset  levels in Table XIX and their policies to coordinate with Part D in Table XXVI. The Report also covers state cost sharing rules and medical criteria and/or prior authorization for special or costly drugs. State formularies are listed in a 2nd adjacent document. See “ADAP Watch” at www.NASTAD.org for news of state waiting lists, cost containment measures & state websites. Check www.ADAPAdvocacyAssociation.org for more ADAP news/ data and for issues of the “ADAP Pill Box”.      

See “Pharm. Benefits [in] State [Medicaid]” at www.npcnow.org on formularies, fees, prior auth, prescribing/dispen-sing limits & co-pays. JCoburn@hdadvocates.org has chart on how Rx maker PAPs mesh to Pt D. States can cover Pt-D-excluded Rx’s with their funds: chart on which do so is at www.medicareadvocacy.org (12/1/05 rpt at “News” icon)

See “Indiv…Models of LTC’ at www.statehealthfacts.org for state coverage of HCB waivers, home health, personal aides, etc. & “Money Follows the Person 101” at www.nsclc.org. See www.healthlaw.org for amounts of 2009 state Personal Needs Allowances (PNAs) for SNF & ICF patients & residents of SSP-funded, licensed board & care homes.

See www.naschip.org on the pre-health reform state risk pools & order “Comp. Health Ins. for High Risk Indivs: .. State-by-State…”on funding, eligibility, benefits, Medicare supplements, premiums & low income premium discounts. www.pcip.gov shows if new US health reform-funded risk pools are state- or federally-run & their premium amounts. Also see “Pre-existing Condition Insurance Plan” (8/10/10) & its excellent bibliography at  www.HealthAffairs.org .  

See the “Directory of..[the 27]..State Kidney Programs”with contact, eligibility & benefit data under “publications” at http://som.missouri.edu/MOKP/ . FL, MI, NJ & TX health depts. also have epilepsy and/or hemophilia aid programs