Alabama--has no spend down, an aged/disabled level of $674/mo (the SSI rate), a parent level of 11%/ 24% if wkng (‘09), an ADAP level of 250%; it covers 12 MD visits & hosp-ital days/yr & 5 brand Rx’s/mo & has an ADAP enrollment cap. The 2010 deficit is $784  million & Gov. Riley (R) & the legislature (D) cut HIV care $2 million but it over-rode his veto of a rise in CHIP’s 200% level to 300%. The risk pool is adding low income premium discounts & has no Medicare supplement. AL won’t run a health reform-funded risk pool.

Alaska----this Title XVI state has no spend down, an aged/disabled level of $1,252 (its SSI/SSP rate), a parent level of 77/81% if wkng (‘09), 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. Gov. Parnell (R) & the legislature (R House; tied Senate) raised the 175% CHIP level to 200% & again offer in-home care services

Arizona--has no spend down or risk pool & covers parents & childless-even non-disabled-  adults under 100%/106% wkng. CHIP’s level is 200% & ADAP’s is 300%. The legislature (R) killed a program to cover the disabled during the 2 yr Medicare wait, cut MD fees &  personal care funds & dropped 10,000 CHIP parents. Gov.Brewer (R), with a $3 billion 2011 deficit; reduced the ADAP formulary (and may start a waiting list & co-pays), cut the  mental health budget, left 35,000 CMI clients in a de-funded limbo with no way to pay for their care, won’t run a US health reform-funded state risk pool & ended hospice & cut in-  home care--but gave up plans to drop 310,000 adults & abolish CHIP (yet retained a CHIP  freeze that’s cut enrollment from 45,800 to 33,700 since 1/10 with a waiting list of 40,000)       

Arkansas—has an aged/disabled level of $674 (the SSI rate), a parent level of 13%/17%  if working (’09), a numerical Rx limit & subsidizes insurance for small firm workers below 200%. Gov. Beebe & the legislature (both D) covered adult dentistry & enacted an as-yet-unfunded bill to raise the CHIP level from 200 to 250%. The risk pool bans Medicare clients but seeks US funds for a low income premium discount. The state may cut the num-ber of covered MD visits & Rx’s. It did cut ADAP’s 500% level to 200%, briefly had a waiting list & cut its formulary.                           

California--The under-funded risk pool (often closed to new patients) has no low income premium discount & bars non-renal Medicare eligibles. Public Citizen says MD fees are the US’ 10^th lowest. The state covers the aged/disabled under 100% (with a disregard of $230, not just $20), parents below 100%/106% if wkng & prostate cancer patients under 200%. Its ADAP level is 400% and CHIP’s is 250%. With a $26 billion deficit, Gov. Schwarzenegger (R) & the legislature (D) raised premiums; capped child dental care at $1,500-$1,800/yr; dropped adult dental and some podiatry & psychiatric benefits; ended non-emergency care for legal aliens; cut provider fees; and slashed HIV services $85 million ($12 million for ADAP). He & both parties in the legislature agreed on a $100 million insurance tax to keep funding CHIP; but a $2.75 billion Medicaid cut caused 3 million adults to lose coverage. He also proposed ending TANF welfare & family medical coverage; home health care & personal aides for the disabled, low income clinic funding; ADAP for county jail inmates; OTC Rx  coverage & adult day health care, limiting Rx’s to 6/mo (except for “lifesaving” Rx’s) & MD visits to 6/yr and imposing a $50 ER co-pay. US courts barred MD & hospital fee cuts, eliminating adult day care & optometry services, a 20% pay cut for personal aides for the disabled and the Gov’s line item vetoes of HIV & other health assistance funding

Colorado---has no spend down. The parent level is 60%/66% if wkng (‘09) & that for those over age 60 is $699 (their SSI+ SSP rate)---but only $674/mo (the SSI-only rate) for the younger disabled. The ADAP level is 400%. The Denver Med. Ctr. & the U. of Col. Hosp. cut their indigent care programs and they & the state indigent medical aid program (for the poor awaiting SSA disability awards) raised co-pays. The risk pool has a low income premium discount for those below $50,000 & a Medicare supplement. Gov. Ritter (D) started a formulary, made private plans cover PTSD, anorexia, substance abuse & colorectal screening, but proposed de-funding 79 mental health facility beds & cutting low income clinic funding---and did cut the ADAP formulary. With a $2.1 billion deficit, Ritter proposed more provider fee cuts & payment delays. Yet he & the legislature (also D) passed a hospital tax to collect $600 million more for Medicaid, CHIP & the state indigent medical aid plan that will raise hospital rates, double uncompensated care funding & cover 100,000 more (raising all adults’ levels to 100%--starting now!--with newly-available US health reform matching funds); applied COBRA rights to small firms & raised the 205% CHIP level to 250%; covered the working disabled under 450%, widen-ed CHIP psychiatric care; started a SPAP for HIV patients; covered legal aliens; and let HMOs sell cheap, barebones policies to the uninsured--but cut funding for DD & other disabled clients’ employment, transportation & personal care aides.

Commonwealth of the Northern Marianas—federal law caps its matching rate far below what states get & it can’t even fully fund its own share of Medicaid even though 37% of residents are poor enough to get it. Its low fees attract few MDs & DDSs (only public clinics), but it enrolled some off-island specialists by agreeing to pay Hawaii’s higher Medicaid fees

Connecticut—a 209(b) state; its 2 zone aged/disabled levels are $784.22 & $888.61(its SSI/SSP rates for those with maximum allowed shelter costs + a $278 disregard), its parent level is 185%/191% if wking; its ADAP level is 400%; its CHIP level is 300% and its risk pool has a low income premium discount for those under 200% and a Medicare supple-ment. Gov. Rell (R) raised SPAP premiums, co-pays & asset levels (its income levels are $25,100 for 1 & $32,900 for 2); limited adult chiropractor, naturopath, psychologist and occu, phys & speech therapy coverage to clinics; but now offers hospice care to all Medicaid patients. Rell moved to cut HIV services $2.7 million, delay starting an HIV HCB waiver, raise some CHIP & Medicaid premiums & co-pays, drop most adult dentistry & eyeglasses and OTC drug, legal alien coverage & cut SPAP benefits.  The legislature (D) covered the working disabled. Rell wants to force patients back into  HMOs to fund her skimpy, subsidized insurance plan for those under 300%. With its original $93-$296 premiums up 72% since 1/1/10, it has big co-pays, limited psychiatric care, low Rx & medical equipt. yearly cost caps, a $100,000/yr total care cap & a $1 million lifetime cap & it may have to freeze enrollment. The state is seeking newly-offered US matching to expand Medicaid to cover childless, non-disabled adults under 133% now on the state Gen Med. Asst. program, length-ened COBRA coverage rights to 30 mos, ended QI’s asset test & raised QMB’s income level to 207%, SLMB’s to 227% & QI’s to 242% (giving most SPAP clients full Pt D Extra Help too). The deficit’s $8.7 billion, Medicaid’s case-load rose 18% in 2009 (33% since 2004) and a key legislative panel voted to raise estate taxes on the rich & for a 5.5% hospital tax.

Delaware---has no spend down or risk pool; covers all adults under 100%, 121% if wkng parents & 110% for childless, non-disabled wkng adults; it has a 500% ADAP level & 200% CHIP & SPAP levels. Gov. Markell & the legislature (both D) fund a cancer care plan for those under 650% & state medical assistance for others under 200% & covered the working disabled. It won’t run its own US health reform-funded risk pool. The state may let over-income children buy into CHIP.

District of Columbia---has no risk pool. Income levels are 200%/207% if wkng for parents, 100% for childless aged & disabled, 300% for CHIP & 400% for ADAP.  A local DC health program covers others under 200%/211% if wkng. May-or Fenty & the Council (both D) covered adult dentistry; boosted the aged/disabled asset level by $2,000, raised the  QMB income level to 300% & dropped its asset test (thus qualifying many DC Medicare patients for Pt D full Extra Help). The next 3 yrs’ shortfalls total $700 million, requiring tax raises & program cuts. DC had to delay plans for provider fee raises & is replacing public mental health clinic care with private contractor services. Fenty proposes cutting funding for low in-come clinics & lowering just-raised MD fees. But DC is now expanding Medicaid to cover childless, non-disabled adults in its local medical assistance program, using new health reform Medicaid matching. The Washington Post ran an investi-gatory series on millions wasted on fraud & ineptitude in DC’s HIV programs. DC plans to keep the insolvent safety net United Med Cntr (formerly Greater SE Hosp) open without seeking receivership or court action in spite of big deficits it’s run even as it got $85-$100 million from DC--which also raised its Medicaid fees to 95%-100% of its overhead costs.

Florida---The GOP legislature got a waiver to privatize Medicaid, using premium support & managed care, starting in a few counties (a court order does let patients opt out). The under-funded risk pool—long closed to new patients---has a Medicare supplement but no low income premium discount. The state cut the aged/disabled level from 88% to the $674 /mo SSI rate, but covers those under 88% in HCB care or those disabled in the 2 yr Medicare waiting period. The parent level is 21%/ 53% if working (‘09) & ADAP’s is 300%. The state covers dentures (but little other adult dentistry) & hear-ing aids. Gov. Crist (R) dropped Zyprexa & Invesa Sustena from the formulary; and wants to let children over its 200% level buy in to CHIP. He signed bills to make private plans cover autism, gut the insurance minimum benefits law & spon-sor barebones policies for the uninsured (see www.coverfloridahealthcare.com ; their start is slated for late 2010). Blue Cross & local health depts. sponsor cheap “Miami-Dade Blue” plans (which don’t cover brand Rx’s); drop hospice & cut dialysis care; and cut mental health & addiction funds & MD fees. With a $2.6 billion 2010-11 Medicaid shortfall, he cut its budget $803 million. In-home & HCB care waiting lists are long, but to settle a suit the state will spend $27 million more on HCB waiver care. Crist restored $22 million for care of the aged, disabled & special needs children for mental health & substance abuse services; raised cigarette taxes $1 to yield $1 billion (partly for Medicaid); and vetoed  nursing home & DD service provider fee cuts. The state required Medigap policies to be sold almost as fairly to the disabled as the aged. With a $230 million 2010 deficit, Miami’s Jackson Mem. Hosp. is closing 2 O/P clinics & 2 transplant units; ending dialysis care for 175 indigents (many of them illegal) & may even have to close its North satellite branch, so the state gave it $50—or, in some reports, $100--million. ADAP just started a waiting list & cut its formulary. The HIV health insurance premium-pay program--short $1.5 million even after getting $1 million from other HIV accounts--has a waiting list of 260

Georgia---has no risk pool. Its aged/disabled level is only $674/mo (the SSI rate), its parent level is 28%/50% if working (‘09), ADAP’s is 300% & CHIP’s is 235%. It has a monthly numerical limit on Rx’s; ended CHIP dental surgery cover-age & raised its premiums; ended adult emergency dentistry & artificial limb benefits and nursing home spend downs; and narrowed Katie Beckett waiver admission rules. Gov. Perdue & the legislature (both R) herded patients into HMOs (but permit opt outs). In spite of red tape, child enrollment still grew 7.7% from 2009 to 2010--but provider fees are too low.Atlanta’s Grady Hosp. was once short $40+ million due to indigent care costs, so it closed its dialysis clinic (but pledged

 to temporarily keep paying for dialysis with other providers for its indigent ex-patients) and 3 of its 9 O/P clinics; and is cutting its free indigent care level from 250 to 125%; but that shortfall has now shrunk to $4.4 million. With a $2.6 billion deficit & a $506 million 2011 Medicaid shortfall Perdue dropped plans for provider fee raises & may cut ADAP $1.2 mil-lion. He’ll sign a 1.45% hospital bed tax bill (its proceeds will attract more US funds to bolster Medicaid hospital fees), but MD & DDS fees will still be cut (again). He seeks insurance taxes & fines to meet health costs, closed a mental hospital building, may privatize much of mental health care and won’t run its own US health reform-funded state risk pool 

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—a 209(b) state with no risk pool. Limited medical assistance covers all adults (even childless & non-disabled) below 200% but full Medicaid (with a 100% level) is closed to childless, non-aged, non-disabled adults. The aged/disabled level is 100% & ADAP’s is 400%. The state covers the working disabled & has a token SPAP for Medicare patients under 100%. Gov. Lingle (R) & the legislature (D) raised CHIP’s level to 300%; ended its premiums (but now charge over-income children to enroll) & proposed ending poor adults’ “free Medicaid”. The legislature dropped plans to raise MD fees, cut HIV services $300,000 & closed ADAP (which has a waiting list of 3) to those with CD4 counts over 350. Suits to block moving 37,000 aged & disabled into controversial managed care plans were dismissed. Lingle cut aged/disabled case management fees, ended non-emergency adult dental benefits & won’t run a US health reform-funded state risk pool

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 wking (‘09), an ADAP level of 200% & a risk pool with no Medicare supplement or low income premium dis-count (and the state won’t run its own US health reform-funded risk pool). The GOP legislature raised the CHIP level from 150% to 185%; funds an under-used pilot plan for adults (even childless & non-disabled) under 185% working in participating small firms, covered the working disabled and categorizes clients in 3 groups: Parents & children; the disabled & chronic cases; and the aged. The 3 groups may get differing benefits or more co-pays but also more preventive care. Gov. Otter (R) covered adult dentistry, but charges premiums of 4% of income to Katie Becket cases (and the legis-lature may even charge all disabled children’s parents extra premiums) and cut hospital, rehab facility & DD agency fees 55% (which a court then barred), plus occup & speech therapy & mental health funds. There’s a 27-person ADAP waiting list & Otter wants to utilize waiting lists in Medicaid too. The House voted to cut already-too-low MD & other provider fees 3.5%, end the state adult cystic fibrosis assistance program & drop coverage of non-emergency transportation to care.

Illinois---this 209(b) state’s aged/disabled level is 100% (with a $25, not just $20, disregard) but its main SPAP excludes those disabled not yet on Medicare, who get only a limited formulary from a 2^nd SPAP. The 2 SPAPs’ income levels were raised to $27,600 for 1, $36,635 for 2, etc.  The legislature (D) raised the parent level to 185%, set ADAP’s at 400%, ac-cepted a court order to raise pediatric fees (yet other state fees are too low & paid very late, with a $4 billion claims back-log), offered subsidized insurance to veterans left uncovered by VA cuts & raised the CHIP level from 200 to 300%. The often-closed risk pool has a Medicare supplement but no low income premium discount. The state is forcing 40,000 aged & disabled into HMOs but raised the working disabled level to 350% & required that Medigap policies be sold as fairly to the disabled as to the aged. The U of Chicago Med. Ctr closed its women’s & dental clinics; and the U of IL at Chicago closed a clinic too. The state found $640 million to subsidize safety net hospitals, made hospitals give the uninsured dis-counts & funded a hospital assessment plan to raise enough to attract $450 million more in US matching. Still, the House  had to make $200 million in as-yet-unspecified Medicaid cuts, while Gov. Quinn (D) hopes to save another $400 million by providing case management to the aged & disabled (38,000 of whom remain on HCB waiting lists). The ADAP short-fall is $10 million, which may well require a waiting list, a formulary cut, cost & enrollment caps & a lower income level.

Indiana---this 209(b) state’s token SPAP for those under 150% excludes the disabled; and it 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% if wkng (‘09). Gov. Daniels (R) & the old all-GOP legislature raised CHIP premiums. The risk pool has a Medicare supplement and a low income premium discount (but the state won’t run its own US health reform-funded risk pool). The ACLU sued to void a once-every-6-yrs denture & re-linings limit. The House (now D) opposed Daniels’ troubled, now-canceled eligibility privatization contract. A class action suit was filed to correct improper case closings, appeals & other contractor errors. The ADAP (with a 300% level) may have to start a waiting list. The state raised the CHIP level from 200 to 300%. A waiver subsidizes insurance for parents below 200%--and it even has 42,000 slots for childless, non-disabled adults under 65 (for which 100,000+ had already applied before enrollment was closed). The insurance offers HMOs, preventive care, few co-pays; yet no dental or vision care. Patients must put 2%-4% of income in HSAs. “Richer” non-Medicare adults can buy-in at full-price premiums. See “Healthy IN...” at www.kff.org & “Profiles: Healthy IN...” at www.statecoverage.net . The deficit is $763 million & Daniels plans to cut provider fees 5% 

Iowa---A waiver with limited Rx benefits covers care for non-Medicare adults—even if childless & non-disabled—under 200%/250% if wkng, but only at 2 public hospitals. The state may seek CMS approval to expand waiver services to let patients get care at low income clinics and (at least) emergency care at any hospital anywhere in the state; but an attempt to raise the level to 300% failed. The aged/disabled level is $674/mo (the SSI rate), the parent level is 28%/ 83% if wkg (‘09) & the ADAP level is 200%. The risk pool has a Medicare supplement but no low income premium discount. The deficit is $565 million. Gov. Culver & the 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 coverage only. Iowa hospitals are proposing a plan to tax themselves $40 million, thus generating enough added US matching funds to raise their own rates & also fund other Medicaid costs. There’s a 77-person ADAP waiting list & the ADAP formulary was cut. 

Kansas---this Title XVI state has an aged/disabled level of $674/mo (the SSI rate), a parent level of 26%/32% if working (‘09), a 200% CHIP level & a 300% ADAP level. Blue Cross & a foundation subsidize insurance for KC-area families under $30,000. The risk pool has no low income premium discount & bans Medicare eligibles. Ex-Gov. Sibelius (D) covered the working disabled, offered state mini-COBRA rights and raised low income clinic subsidies. The legislature raised the CHIP level to 250%, but wouldn’t fund previously-authorized adult eligibility expansions or hire enough workers to cut a 12,000-application backlog & cut funds for eligibility staffing. There are 5,700 persons now on waiting lists for services for physically disabled & DD patients, yet the state cut in-home services for the aged & disabled. With a $238 million deficit, Gov. Parkinson (D) seeks a 1 cent sales tax raise--and the state’s hospitals favor a tobacco tax boost, while the nursing homes favor taxing themselves, with the proceeds used to attract more US matching with which to raise their rates---to avert those cuts: such as more use of pre-authorization, adding co-pays for un-needed ER visits, starting a case management program for psychiatric Rx’s & cutting admissions to state DD facilities. The state already raised CHIP premums by $10 to $20 monthly and froze new admissions to the 3 now-chronically-over-crowded state mental hospitals.  

Kentucky--- has an aged/disabled level of $674/mo (the SSI rate), a parent level of 36%/62% if working (‘09), 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 only 4/mo, limited occupational, physical & speech therapy, x-rays & MRIs; raised co-pays; and divided Medicaid into 4 different groups: “healthy” adults; children; aged & disabled; and MR & DD patients: See http://www.kff.org/7530.cfm . The risk pool has no low income premium discount or Medicare supplement. Gov. Brashear (D) faces a 2010-12 deficit of $888 million to $1.4 billion, with Medicaid & CHIP costs swollen $242.5 million in 2010 but says he’ll save Medicaid $108 million in 2010-11 with more efficiencies & a new anti-smoking benefit, with no service or coverage cuts. He expanded CHIP outreach, enrolled 22,000 more children & dropped the $20 CHIP premium. There’s a 200-person ADAP waiting list, client co-pays are required & the formulary was reduced. 

Louisiana---has an aged/disabled level of only $674/mo (the SSI rate), a parent level of 11%/25% if working (‘09) & a 300% ADAP level. Its risk pool has no low income discount & bans Medicare eligibles (and the state won’t run its own US health reform-funded risk pool). The legislature (D) voted to raise CHIP’s 250% level to 300% but can’t afford to. Gov. Jindal (R) got CMS to agree to the state refunding only $266 million (to pay back much more in overpayments) & sought a waiver to cover parents under 50% in New Orleans, Baton Rouge & Shreveport plus all adults under 200% in Lake Charles. He proposed cuts of $531 million+ by cutting covered Rx’s from 8 to 5/mo (unless more are “medically justified”), lowering MD & hospital rates, cutting funding for & privatizing community services & HCB waiver care for aged, CMI, disabled & DD clients & possibly capping ADAP enrollment. US matching falls $700 million in 2011, 2010’s deficit’s $1.7 billion & the state plans $340 million more in provider fee cuts. FEMA will pay $478 million to re-build the N. O. State Charity Hosp; the state will add $300 million more & have to find $70-$100 million/yr to subsidize operations  

Maine---Gov. Baldacci & the legislature (both D) set these income levels: subsidized health insurance, 300% (with up to $8 million in premium subsidies now available even for part-timers); the aged & disabled, 100% (with a $75, not just $20, disregard); childless, non-disabled adults, 100% (once closed, it’s now taking up to 2,000 new applicants); parents, 200% /206% if wkng;  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 favors an employer play or pay rule, reforming hospital funding & starting risk pool & reinsurance plans. Adult dentistry covers little but dentures. There are no MSP asset tests & QMB’s income level is 150%, SLMB’s is 170% & QI’s is 185%. He raised cost-sharing for those over 150%, cut podiatry care, seeks $108 million in health cuts & lowered provider fees & may start an ADAP waiting list 

Maryland---has an aged/disabled level of only $674/mo (the SSI rate), a parent level of 116%, a CHIP level of 300%  (with a 6 mo waiting period for some new applicants) & an ADAP level of 500%. 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 spread to his brain & killed him, so UnitedHealth funded an indigent child dentistry program. The risk pool liberalized its low income premium discounts for those under 200%, yet has no Medicare supple-ment. 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 $2.7 billion deficit at first forced him to delay a 2^nd planned expansion of full Medicaid to childless (even non-disabled) adults under 116% (but he’ll  now carry out both adult expansions with newly-available US health reform matching funds) & to cut $90 million more in health funding for fees to providers, HMOs, HCB programs & personal aides for the disabled. And he plans $300 million more in health cuts---including closure of a state mental hospital & a $180 million nursing home fee cut (yet he & the homes hope to more than make that up with later rate increases that will be funded from a 2% tax they’ll pay that will attract more US Medicaid matching money). He’s funding a $42 million child dental fee raise; is carving child dentistry out of HMO contracts for direct state managing; and made hospitals give free care to those under 150%  

Massachusetts---has no risk pool. Ex-Gov. Romney (R) signed the legislature’s (D) bill to expand Medicaid; require everyone to have insurance; subsidize it for those under 300%; boost the CHIP level from 200 to 400%; and raise the parent & childless disabled Medicaid levels—but not the childless aged level, which is only 100%--to 133%. The ADAP level is 488% & the SPAP’s is 188% (but up to 500% for Pt D patients). Gov. Patrick (D), with a deficit of $1.2 billion & a $200-$300 million Medicaid shortfall in 2009 (plus even bigger ones for 2010 & 2011), boosted Medicaid & subsidized insurance premiums & co-payments; raised SPAP cost-sharing; proposed freezing MD & hospital fees; and cut $74 million for substance abuse, tobacco cessation & school RNs, plus $20 million for pregnancy prevention. The state restricted coverage of 31,000 legal aliens to limited I/P hospital & low income clinic care, but it now needs $75 million more just to continue even those skimpy benefits. With the deficit now $575 million higher, Patrick proposed a $265 million Medicaid cut that would confine adult denture & root canal services to community health centers; raise MD & Rx co-pays (even for generics); require prior approval for costly psychiatric Rx’s; end personal aide care for those getting it less than 15 hrs/wk; and cut hospital fees. Patrick sought to raise employer taxes to keep funding a state program to pay COBRA premiums for the unemployed, proposed requiring college students to be insured & seeks $331 million in federal funds to cover deficits at 7 safety net hospitals. The legislature is considering forcing aged dual eligibles into HMOs. 

Michigan---has no risk pool; an aged/disabled level of 100%, a parent level of 37%/64% if working (‘09), a CHIP level of 200% & a 450% ADAP level. It ended adult dental, hearing aid, podiatry & chiropractic coverage & briefly ceased en-rolling new cases in its O/P care-only waiver for childless, non-disabled adults under 35%/45% if wkng. Gov. Granholm (D) & the old GOP legislature raised co-pays, restored adult dentistry & raised child wellness, dental & adult preventive fees. Counties containing Flint, Lansing, Muskegon & Detroit offer coverage to those under 200%---and Oakland Co. was considering doing so with state facilitation. With a $2.8 billion deficit & ½ million more patients in 2009, the House (now D) & Senate (still R) cut Medicaid MD, hospital & mental health fees by $165 million; again dropped adult podiatry, chi-ropractic & dentistry (but after an untreated tooth infection killed a patient, a suit was filed to bar the cut); and ended adult vision care. The Senate (R) killed Granholm’s plans for a 3% MD & other minor taxes to avert cuts; and its GOP leaders want to drop some mental health care & “optional” services and coverage of childless, non-disabled 18-to-21-year-olds    

Minnesota---this 209(b) state has an aged/disabled level of 100%, a regular, full Medicaid parent level of 215%/ 219% if wkng (‘09), 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 (and it won’t run its own US health reform-funded risk pool). Gov. Pawlenty (R) raised premiums & co-pays for Medicaid, CHIP & MinnesotaCare (state-subsidized insurance for parents under 275% & childless, non-disabled adults below 250%) and denied Medicaid & CHIP to legal aliens, although he did end ADAP co-pays & covered the working disabled. But with a $4.63 billion deficit, he cut hospital rates $90 million & MD fees by 7% and capped enrollment in HCB care for the disabled. He proposed cutting funding for personal aides for the disabled and tightening medical qualifications & hours of coverage for aides, nursing home & HCB waiver care; raising some client premiums; ending coverage of occu & speech therapy & audiology; dropping adult dentistry, removing 20,000 childless adults & parents from MinnesotaCare (single adults would have lost any state medical coverage, while parents would instead have had to meet Medicaid’s much lower income levels); and cutting parent asset levels. Pawlenty & the legisla-tive majority (D) agreed to a compromise to preserve a cheaper, barebones GMA---with stingy block grants totaling less than ½ the previous GMA budget for participating hospitals to care for its patients. Hennepin Co.’s Med Center can’t keep treating other counties’ indigents without being paid by them, so it had to cut mental health, dental & HIV services. And 45 of the 48 other Minnesota hospitals wouldn’t at first agree to become providers in the new GMA plan because the grant amounts are far below the cost of care. Then Pawlenty & the legislature (D) agreed to a 2^nd compromise authorizing him or his successor, at his or her sole discretion, to move the GMA patients into US-matched Medicaid, as now allowed by the US health reform law (which he himself strongly refuses to do). He boosted the appeal of the new, low GMA grants to  hospitals (convincing only Hennepin & 3 others so far) by fixing ceilings on the number of GMA patients each hospital must take. The MN Children’s. Hosp, with 40% of its income from low Medicaid & CHIP fees, has to drop some services   

Mississippi---has no spend down; its risk pool has no low income premium discounts & no Medicare supplement (and the state won’t run its own US health reform-funded risk pool). Gov. Barbour (R) cut the aged/disabled level from over $1,000/mo to 80% ($724; but with a $50, not just a $20, disregard). The parent level is 24%/44% if working (‘09), CHIP’s is 200% & ADAP’s is 400%. Only 2 brand Rx’s & 3 generics are allowed monthly (HIV patients get 5 brand Rx’s & there’s a suit against the limits). Barbour cut Rx fees & physical, speech & occupational. therapy benefits. An in-person re-application rule limits enrollment, which he & the Senate (D) won’t drop--except maybe for LTC clients—even though the House (also D) wants to. With a budget shortfall, Barbour cut provider fees 5% & will do so again, may add premiums & raise co-pays but did secure new cigarette & hospital taxes. He also cut subsidies for community mental health centers, proposed closing 4 mental hospitals & 15 mental health crisis centers & opposes using reserve funds to bolster Medicaid  

Missouri---is a 209(b) state. Its risk pool has no Medicare supplement but has a low income premium discount (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; dropped the working disabled; cut the parent level to 19%/ 25% if wkng (‘09); ended adult dental, podiatry, hearing aid & vision benefits; 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 now covers the 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 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 legislature (still R) to partially restore the parent level (to 50%, but it refused); cover all adult dental, hearing & vision care (also rejected); and liberalize CHIP premiums & coverage (killed too). A big deficit & a caseload up 40,000 since 1/09 caused Nixon to drop plans to restore the 100% aged/disabled level & do more enroll-ment outreach (in fact, new red tape actually delays enrollment). He’s seeking a $139 million cut in hospital rates & $32 million in other health cuts (i.e., in MD & DDS fees, mental health, other hospital & lower public clinic subsidy funding); and reduced the ADAP formulary. The House & Senate are nearing agreement on requiring private plans to cover $36 to $55 thousand/yr in autism care. CMS found the state home health care benefit to be improperly limited to the homebound

Montana---has an aged/disabled level of $674/mo (the SSI rate), a parent level of 32%/56% if working (‘09) & an ADAP level of 330%.Its risk pool has low income premium discounts for those under 150% & a Medicare supplement. The state raised cost-sharing, cut LTC & hospice benefits & access and aged/disabled MD visits to 10/yr. Gov. Schweitzer (D) & the legislature (R Sen; tied House) ended a CHIP waiting list (but ADAP has an 18-person one); seek a waiver to cover 3,000 more (maybe even childless non-disabled) adults; raised the family asset level; began a SPAP for Medicare patients under 200%; widened CHIP dental & preventive care; and made private plans offer vaccines & well-child care to age 7. A referendum raised the CHIP level (a 2^nd time) to 250%, but systems and processing problems are slowing child enrollment

Nebraska---is a Title XVI state with a one-house “non-partisan” legislature. Its aged/disabled level is 100%, its parent level is 47%/58% if working (‘09), its CHIP level is 185% & ADAP’s is 200%. It ended Medicaid for many parents who leave welfare to work (but a court barred denying Medicaid to those who don’t meet work rules). The risk pool has a Me-dicare supplement but no low income premium discount (and the state won’t run its own US health reform-funded risk pool). Gov. Heineman (R) covered Pt. D co-pays for HCB & board & care clients and raised CHIP’s 185% level to 200%. With a $334 million deficit, he may cut provider fees, limit dental care to $1,000/yr, hearing aids to 1 every 4 yrs, eye-glassses to 1 pair each 2 yrs, and adults to 12 chiropractic visits & 60 occu, speech & phys therapy sessions/yr. An ADAP waiting list has 21 on it & its formulary was cut. After Nebraska Medicaid stopped covering pregnant aliens & their fet-uses, the U of NE Med Ctr began to cover them in its own indigent program & the state widened school-based health care  

Nevada---a Title XVI state with no spend down & no risk pool (and the state won’t run its own US health reform-funded risk pool); its disabled level is $674/mo (the SSI rate), while the aged-only level is $710.40 (their SSI/SSP rate); its regular Medicaid parent level is 25%/88% if working (‘09); its CHIP level is 200%; its ADAP level is 400%. It subsidizes insurance for parents under 200% working for participating small firms and covers the working disabled. Its SPAP, with a 225% level, covers the disabled and even offers a vision benefit; but it raised CHIP premiums---which Gov. Gibbons (R) wants to again boost by tripling them. With a $2.8 billion deficit he & legislature (D) capped CHIP dentistry at $600/yr, ended CHIP orthodontia & vision care, tightened SNF, ICF, HCB waiver & at-home care medical qualification rules, reduced pregnancy coverage, cut hospital rates 5% to 14% (closing the U of Nev. at Las Vegas Hospital’s dialysis & oncology clinics) and slashed HCB waiver fees. The legislature rejected his attempts to drop coverage of adult dentistry, dentures, hearing aids, vision care, adult day care, brain trauma care & adult diapers; but it did cut attendant funds for the disabled; limited non-emergency transportation and cut hospital neonatal & pediatric specialist fees. The HIV agency cut its Las Vegas-area budget $1 million & rising numbers of indigent, non-paying patients is saddling the state’s low income clinics with big budget shortfalls. The legislature set up a preferred list of anti-psychotic, anticonvulsant & diabetic Rx’s   

New Hampshire---a 209(b) state; its a risk pool has no Medicare supplement but recently added low income premium discounts for those under 250%. Its aged/disabled level is $714 (the SSI/SSP rate; the disregard is $13, not $20/mo), its parent level is 39%/49% if wkng (‘09), 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 & the legisla-ture (both D) shifted some LTC costs to counties & ended a DD care waiting list. He & the legislature made-- will make more--cuts in hospital, MD, LTC & mental health fees. The deficit’s $75 million; US auditors want $35 million in over-claimed DSH funds back & FY 10 Medicaid costs are $43 million over budget. NH lets 19-to-26-yr-olds buy into CHIP 

New Jersey---has no risk pool, an aged/disabled level of 100%; an ADAP level of 500%, and SPAP levels of $31,850 for 1 & $36,791 for 2.; A waiver covers others (even childless & non-disabled) under 100%. The legislature (D) required cov-erage of all children & raised the parent level to 200%. Public Citizen said NJ provider fees were the US’ lowest, so the state raised many pediatric rates. One audit questions $52 million in school health costs, a 2nd said hospital indigency pro-grams fail to collect millions from other liable payers & a 3^rd found 75,000 clients to have 2 or more Medicaid I.D. num-bers. A court barred an assisted living facility chain from refusing to let patients remain using Medicaid when their funds run out. With an $11 billion deficit, the state cut hospital charity & teaching and day health center funding; cut the SPAP formulary & raised its co-pays---but boosted MD fees & low income clinic funding and ended CHIP premiums for those under 200%. Gov. Christie (R) seeks to drop adult legal aliens & freeze enrollment of parents---but the legislature (D) forced him to drop plans to raise SPAP brand Rx co-pays from $7 to $15 & require $310/yr deductibles---yet he appar-ently still wants cuts in women’s & infants’ reproductive & health services—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 working (‘09), CHIP’s is 235% & ADAP’s is 400%. A waiver—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 working. Med-

icaid’s shortfall will be $300 million by 1/1//11 (it’s $40 million now), so Gov. Richardson & the legislature (both D) dropped expansion plans; and may end adult dental, vision, hearing aid & hospice coverage; slash phys, occu & speech therapy; cut mental health/substance abuse benefits & fees; and cut or even drop Rx coverage and HCB waiver services. 

New York---has no risk pool. A “FamilyHealth” waiver covers parents & all couples under 150%, and childless (even non-disabled) single adults under 65 below 100% (but the level is only $767/mo for childless aged singles). ADAP’s level is 431%. The state subsidizes insurance for workers under 250%, but caps plan Rx benefits at $3,000/yr. The legislature (with both Houses now D) still excludes the disabled from the SPAP (which has a 350%+ level); won’t cover digital mammograms; raised Rx & MD co-pays (capping them at $200/yr); adopted a loose formulary; covers assisted living, chore aide & adult day care; makes counties pay 1/2 of state Medicaid costs (but caps their cost increases 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 and the working disabled under 250%; required hospital bill discounts for those under 300% & forbade taking debtors’ homes; passed mental health parity; and raised the CHIP level from 250 to 400%. Public Citizen said MD fees are the US’ 2^nd lowest, so NY began to raise its fees to 70% of Medicare’s. Ex-Gov. Spitzer (D) planned to let small firms that can’t afford insurance buy into FamilyHealth at low rates. With a $15+ billion deficit, Gov. Paterson (D) signed a $1 billion hospital & nursing home fee cut; started a discount Rx plan for the near-poor disabled; raised asset levels for all clients ($13,050 for 1, $19,200 for 2, etc); ended MSP & SPAP asset tests; extended all COBRA rights to 36 months; but sought to cut Medicaid & mental health $471 million more, slash HIV care $6 million & force NYC HIV & all dually-eligible patients into HMOs. He wants to raise the level for all adults to 200% (only as funds permit); but proposed a $65 million group home cut (yet a US judge then told the state to move 4,300 mentally ill into smaller, better group homes) & $1 billion more in hospital & nursing home fee cuts. Short $316 million, NYC’s hospitals plan to cut child mental health & O/P Rx benefits & close some clinics. NYC proposed to end its school dental program & cut HIV services $17 million. NYC’s safety net St. Vincent Hosp. had to close. Paterson proposed cutting NYC’s public hospital subsidies $370 million and spending new payroll & wine taxes (plus Rx legal settlement funds) on Medicaid, ADAP, the SPAP & mental health.  

North Carolina---covers the working disabled, but allows only 8 Rx’s a month (plus another 3 or more on an exception basis).Its aged/disabled level is 100%; its parent level is 36%/49% if working (‘09) & its CHIP level is 200% (the deficit barred plans to raise it). The SPAP– which excludes the disabled—subsidizes Pt. D premiums for those under 175% who aren’t on full Extra Help. The UNC Hosp. eased its indigent care rules. Ex-Gov. Easley & the legislature (both D) set up a 2^nd SPAP for ADAP clients on Medicare who are not eligible for Pt D’s full Extra Help, passed limited mental health par-ity & started a risk pool that excludes Medicare patients, requires pre-authorization and has a $250 co-pay for “specialty” Rx’s & a $100,000/yr out-of-pocket maximum but has low income premium discounts. A $2 billion deficit moved Gov. Perdue (D) to seek $30 million in manufacturer rebates by adopting a preferred drug list; to propose closing 50 state mental hospital beds and cutting MD & hospital fees $76 million; home personal care $55 million (with an 18 hr/wk limit); ad-ult dentistry 50%; community mental health $250 million (but later called for restoring $40 million of it); care for the un-insured $40 million; & mental health fees 5%. The budget cuts audiology, speech, phys & occup therapy & hospice fund-ing, ADAP by $3 million (causing an enrollment freeze, a 506-person waiting list, a formulary cut limiting coverage to Tier 1 Rx’s & a reduction of the ADAP level from 300 to 125%); ends a Medicaid HIV case manager program, commun-ity-based rehabilitation services & coverage of many child dental X-rays & sealants; limits diabetic supplies to 1 provid-er; and requires prior approval of X-rays, MRIs, MRAs, PET scans, ultra-sounds & some EPSDT services. With 2011’s Medicaid shortfall projected to be $475 million, legislators may pass a hospital tax to bridge the gap—with its proceeds attracting 3-to-1 US matching, enough to do so while also more than compensating hospitals for the tax with higher fees. 

North Dakota---this 209(b) state has a risk pool with a Medicare supplement but no low income premium discount. Its aged/disabled level is $750, its parent level is 34%/59% if working (‘09) & ADAP’s is 400%. Gov. Hoeven (R) covered disabled children via the FOA (up to 200%), boosted CHIP’s level to 150% & raised the one person Medicaid medically needy/spend-down-to level from $500 to $750/mo. The GOP legislature refused to again raise the CHIP level (to 200%). It may cut the ADAP formulary, cap its costs & enrollment and start a waiting list (it did limit access to Fuzeon Rx’s).

Ohio--this 209(b) state with no risk pool cut the parent level from 100% to 90% and has a 500% ADAP level. It slashed adult dental funds 50%; cut secondary fees for dual eligibles & medical aid 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; passed mental health parity; but has an aged/disabled level of only $589/mo (the US’ very lowest). Gov. Strickland (D) & the legislature (R-Sen; D House) raised the CHIP level from 200 to 300% (to be 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, but cut local eligibility work funding & nursing home fees (the legislature then partially restored the fees & bolstered home care benefits). He cut pharmacy Rx dispensing fees & community mental health funds; imposed Rx co-pays & a generics preference rule (hoping to save $243 million); delayed MD, DDS & hospital fee raises & fully restoring adult dentistry, may cut the ADAP level & impose co-pays, told nursing homes to pay for patients’ phys therapy, wheel-chairs & medical equipment (which some homes can’t or won’t do, leaving some patients without needed care or equipment), moved 592 from a waiting list into HCB waiver care, signed a bill imposing $718 million in hospital “fees” (to attract more US matching, with which to then raise rates); and signed a bill extending mini-COBRA rights for small firms  

Oklahoma---this 209(b) state has a risk pool with no Medicare supplement or low income premium discount. It cut the aged/disabled level from 100% to $718 (the SSI/SSP rate). The parent level is 31%/47% if working (‘09) & ADAP’s is 200%. It abolished its parents & children spend down, has a 3-Rx’s/mo limit & doesn’t cover hospices. Gov. Henry (D) covered the breast/cervical cancer & working disabled groups, and got a waiver to subsidize insurance for students, the unemployed and workers & spouses in small firms under 200%. Employer eligibility was later widened & the GOP legislature lowered plan premiums—but cut its benefits too. It also authorized Medicaid coverage of assisted living; raised the CHIP level from 185 to 300%; encourage HSAs in employer plans (and maybe even in Medicaid); and gutted the insurance minimum benefits law. The deficit is $612 million & the ADAP adopted economies. With a $26.6 million Medicaid budget cut, the state may drop coverage of pregnant women’s dentistry, durable medical equipt & nebulizors .It slashed dialysis & diabetic supply fees; cut hospital, MD & nursing home fees 3.5%; and raised co-pays. It seeks to limit ER visits to 3/yr, make $16 million in mental health cuts (affecting 55,000 patients) and is closing 200 state mental hospital beds It did cut covered brand name Rx’s from 3 to 2/ mo; ended coverage of speech, physical & other O/P therapies but has so far failed to pass a 1% paid health claims tax to attract 3-to-1 added US matching funds to meet growing Medicaid costs 

Oregon---this Title XVI state’s risk pool has no Medicare supplement but has low income premium discounts for those under 185%. Its income levels are $674/mo for the aged & disabled (the SSI rate), a 32%/40% if wkng Medicaid parent level (‘09), 185% for a non-Medicare adult insurance subsidy (with closed enrollment) & 200% for ADAP. An anti-tax referendum cut coverage & adult dentistry & ended adult vision care. The OR Health Plan waiver--with limited benefits for non -Medicare (even non-disabled or childless) adults under 100%--began again, but then stopped, taking applications. ADAP has cost-sharing & a waiting list & formulary cut may be needed. Short $4.2 billion, Gov Kungoloski & the legislature (both D) took the FOA option & passed insurer & hospital taxes---later upheld in a referendum that raised taxes on the wealthy too--to cover 80,000 more children (raising CHIP’s level to 300%), 35,000 more adults & more in-home care

Pennsylvania---has no risk pool, an aged/disabled level of 100%, a parent level of 26%/34% if working (‘09), a CHIP level of 300% & an ADAP level of 350%. It subsidizes a barebones “AdultBasic” insurance (it has no mental health or Rx benefits; the 390,000 on its waiting list can buy similar coverage for a $600/mo premium; but AdultBasic’s own increas-ingly ill clientele & growing costs required $20 MD visit co-pays & a $1,000/yr hospital care cap) for non-Medicare adults under 208%/213% if working. Gov. Rendell (D) covered the working disabled, raised the SPAP levels (to $23,500 for 1 & $31,500 for 2, enough to cover 90,000 more seniors, but still not the disabled), applied 9 month state mini-COBRA rights to small firms & sought a $106 million hospital rate cut. But Senate (R) leaders want much deeper cuts & even pro-posed freezing CHIP funding. Public Citizen says PA MD fees are the US’ 5^th lowest. The deficit is $3.2 billion+. A short-fall forced Phila city clinics to charge fees of $5 to $20 & close some sites. The House (D) twice voted to expand Adult Basic (to cover 85,000 more persons & add Rx & mental health benefits) but anti-tax Senate leaders have blocked the bills 

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

Rhode Island---has no risk pool, and these levels: aged/disabled,100%, parents, 175%/181% if wkng, CHIP, 250% &  ADAP, 400%. It covers the working disabled & its limited formulary SPAP covers the aged but only those disabled over age 55 (with levels of $37,167 for 1 & $42,476 for 2). Gov. Carcieri (R) required free & discounted hospital care for those under 200% & 300% & banned taking debtors’ homes. Public Citizen says MD fees are the US’ 3^rd lowest. Big deficits ($660 million in FY10) moved him to get a waiver with extra up-front US funding that in exchange requires the state to divert 12% of nursing home cases to cheaper home care & puts a cap on future US funds. See“RI’s Medicaid Proposal...” at www.cbpp.org . The legislature (D) raised adult daycare co-pays and also dropped legal alien children and 7,400 adults.  

South Carolina---has no spend down. Its aged/disabled level is 100%, its parent level is 48%/89% if working (09) & its ADAP level is 300%. Its risk pool has a Medicare supplement but no low income premium discount (and the state won’t run its own risk pool with US health reform funding). Gov. Sanford & the legislature (both R) limited Rx’s to 4/mo& raised the CHIP level to 200% (but he then proposed closing enrollment). The SPAP level is 200%, but it excludes thedisabled. The legislature cut Medicaid mental health benefits, closed an HIV program to new clients and slashed homehealth, hospital & nursing home fees and SPAP benefits—yet passed private plan mental health parity. The legislature passed raised tobacco taxes to bolster Medicaid, bringing a Sanford veto, which the House—but not yet the Senate—then voted to over-ride (yet it also voted to cut SPAP funds and the state will end all its own ADAP funding (in spite of a waiting list of 81), cut in-home care of the disabled, slash covered Rx’s from 4 to 3/mo & end funding of cancer screening.  

South Dakota---has no spend down & a risk pool with no low income premium discount that excludes Medicare patients. Its aged/disabled level is $674/mo (the SSI rate), its parent level is 52% (‘09) & ADAP’s is 300%. Rejecting a call for expansion, Gov. Rounds & the legislature (both R) refused to raise the pregnant woman & CHIP levels to 250% or provider fees and ended adult dentistry. The deficit’s $81 million & there’s a 30-person ADAP wait list & its formulary may be cut

Tennessee----Gov. Bredeson (D) & the legislature (R) dropped 191,000 when ending the Tenncare waiver expansion. The aged/disabled level is now $674/mo (the SSI rate), the parent level is 70%/129% if working (‘09) & ADAP (which no lon-ger has a waiting list) has a 300% level. Except for pregnant women, 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 (enrollment in it was to have re-opened 3/1/10), a risk pool (with no Medicare supplement but with a premium discount for those below 250%, for which the state won’t take US health reform risk pool funding), a SPAP (with a waiting list) covering up to 5 generics/mo (with a low benefits cap) for non-Medicare patients under 250% & state-subsidized barebones insurance for non-Medicare adults under $55,000 (enrollment is closed). Besides also cover-ing diabetic items & more psychiatric Rx’s, CHIP uses Medicaid Rx rules. The spend down was revived, but Bredeson cut its (plus the home care & medical equip) budget & benefits promised to the disabled who lost Tenncare. The deficit is $1.25+ billion, forcing closure of 600+ mental hosp. beds, big mental health cuts & hosp rate cuts of $500 million—caus-ing shortfalls at Nashville Gen. Hosp (which had to deny non-emergency care to indigent illegals) & Memphis Reg Med Ctr  Bredeson deferred caps on MD visits, transport & transplant care, but kept a $10,000/yr benefits cap; ended occup, speech & phys therapy benefits & capped  X-ray & lab usage & ADAP costs. A court voided a 1987 order grandfathering-in 150,000 ex-SSI recipients to Medicaid--almost all ineligible under 2010 rules; see “Daniels Case” at www.tnjustice.org

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% if working (‘09) & 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 monthly; moved patients into HMOs; contracted-out eligibility work--but restored Medicaid mental health, vision & hearing aid coverage and CHIP mental health & dentistry (limited adult dentistry is covered too); required some mental health parity in private plans; and have a SPAP for HIV clients. A non-profit agency (www.TexHealthCoalition.org) fosters subsidized discount 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 children’s care requires raising MD & DDS fees (but all provider fees are now being cut); and the 2011 deficit is $11 billion (mostly due to 350,000 new Medicaid enrollees in 2009-10).

Utah—a Title XVI state with a risk pool--with a low income premium discount, but no Medicare supplement. Its aged/ disabled level is 100%, its parent level is 38%/44% if working (‘08) & 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 or non-disabled) under 150%. The legislature (R) ended coverage of podiatry, audiology, speech therapy, chiropractic, outdoor wheelchairs & adult eyeglasses & dentistry (one patient died after an untreated tooth infection spread to her brain); cut hospital & DDS fees 25%; and may cut CHIP dentistry more. Ex-Gov. Huntsman (R) began a subsidized premium program for small firm workers under 150% (see “New CHIP /UPP Waiver..” at www.healthpolicyproject.org) A legislative reform panel would gut the minimum benefits law; ban pre-existing condition rules; and urge employers to offer workers HSAs over regular insurance—and its suggestion that the state let insurers sell cheaper-than-COBRA policies was enacted. The deficit is $272 million. Gov. Herbert (R) restored dental benefits for children & pregnant women & some physical & occupational therapy. Yet he & the legislature cut DDS fees 28.8% (which CMS disapproved); began an ADAP waiting list (with 97 on it) and cut its formulary & income level (to 250%); closed enrollment in Gen. Assistance welfare for those awaiting SSA disability awards (which then impedes access to already-hard-to-get Gen. Medical Asst. care); and may slash the disabled income level from 100 to 74%, cut school health funds, reduce the pregnant woman asset level; and even drop the spend down. Legislators are considering a $23 million hospital tax to attract $50 million more in US Medicaid matching funds.

Vermont—Its income levels are: aged/disabled, 100% & 110% (2 zones), parents, 185%/191% if wkng, childless, non-disabled adults, 150% /160%, if wkng, CHIP, 300%, ADAP, 200% & the SPAP, 175%. The state subsidizes insurance for others under 300%. The legislature (D) voided Gov. Douglas’ (R) adult dental cuts (but dentures still aren’t covered & there’s a $495/yr cap on per-patient benefits costs). A waiver, in return for more US funds, puts patients into HMOs & favors HCB care over nursing homes--but caps future US matching funds. There’s no risk pool. The deficit’s $100 million & 2011’s health & human services shortfall is $53 million. He pledged to not cut eligibility, yet raised SPAP co-pays & seeks more cost-sharing (but the legislature won’t raise CHIP premiums), a cap on ER visits and provider & Rx fee cuts

Virginia---a 209(b) state with no risk pool (and the state won’t run its own US health reform-funded risk pool). Its aged/disabled level is 80%, its parent level is 23/29% if working (‘09), CHIP’s is 200% & ADAP’s is 400%. The state covers the working disabled & has a SPAP for HIV+ Pt. D patients under 300%. With a $2.7 billion deficit & Medicaid costs up $777 million in 2 yrs, both cuts & new taxes seem needed--but Gov. McDonnell & the House (both R), rejecting less stringent Senate (D) ideas, ordered Medicaid provider fee cuts, a big mental health community care cut, a near-freeze on HCB waiver placements (the HCB waiting list is already 6,000), a 5% cut for local mental health & substance abuse agency funding and a delay or freeze in CHIP enrollment (which could turn away 28,000 children & pregnant women).

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 working (‘09) & ADAP’s is 300%. Gov. Gregoire & the legislature (both D) passed mental health parity. Facilities evicted 75+ assisted living clients due to too-low state fees. A $9 billion deficit didn’t stop the state from raising the CHIP 250% level to 300%. The state raised Basic Health (state-subsidized insurance for non-Medicare adults under 200%, with a waiting list of 100,000) premiums & co-pays; cut Gen Med Assist $190 million (dropping 3,000 patients), DSH payments & nursing home fees; and limited drug, DME, imaging, denture, diabetic supplies, personal assistant & in-home care hours, adult day care, maternity & infant case management & incontinence benefits and cut druggist, pediatric, HMO & day health center fees. It may drop adult eyeglasses, dentistry & colorectal cancer screening. The Legislature may let over-income children buy into a CHIP-like plan. ADAP’s formulary was cut, cost-sharing was imposed and the Gov. proposed a 25% cut in other HIV services. The state is seeking insurer bids to offer the uninsured a barebones policy at $100/mo and is exploring using newly-available US health reform matching to now fund the merging of BasicHealth into Medicaid  

West Virginia---has an aged/disabled level of $674/mo (the SSI rate), a parent level of 17%/33% if working (‘09) & an ADAP level of 250%. It covers only 4 brand Rx’s/mo (+6 generics). Its risk pool has no Medicare supplement but is authorized to give low income premium discounts. It denies all adult dental care but extractions & didn’t properly adopt nursing home & HCB medical admission rules (which still impede access). Gov. Manchin & the legislature (both D) started an Rx aid plan for non-Medicare adults under 200%; but their program giving clients more mental health care & Rx’s in exchange for signing personal responsibility pledges is being halted by CMS .Manchin raised the CHIP level to 250%, may raise child dental fees but plans to herd the disabled into physical & mental health managed care programs.   

Wisconsin---has an aged/disabled level of about $757.78/mo (the SSI/SSP rate), a 200% parent level & a 300% ADAP level. The SPAP has a 240% level but excludes the disabled. The risk pool has a Medicare supplement & premium dis-counts for those under $33,000. Gov. Doyle & the legislature (both D) raised the CHIP (185 to 300%) & parent (185 to 200%) levels, made private plans cover child hearing aids & cochlear implants and funded “Basic Care” (but not brand name Rx’s) for up to 54,000 non-Medicare childless adults under 200% With a $700 million deficit, health programs $150 million over budget, Medicaid staff now making $600 million in cuts & needing to cut $1 billion more in 2011 & Basic Care enrollment already over its funding capacity (plus 51,000 more on a waiting list or yet to be processed), he closed Basic Care enrollment & proposed a skimpier non-federal plan with $50-$100/mo premiums for remaining cases (which the legislature is expected to authorize) and a $900 million hospital tax to raise hospital rates by attracting more matching  

Wyoming---has no spend down; an aged/disabled level of  $699 (the SSI/SSP rate), a parent level of 40%/52% if working (‘09) & a CHIP level of 200%. Its SPAP covers non-Medicare clients below 100%. The legislature (R) added mental health, vision & dentistry to CHIP. Gov. Freudenthal (D) added a low income premium discount for those under 250% to the risk pool (which has a Medicare supplement, but the state won’t run its own US health reform-funded risk pool) & favors a pilot insurance subsidy program (which had been nearing passage in the legislature) for low income workers but wants to freeze CHIP enrollment. 2010’s Medicaid costs rose $100 million, so he and the legislature plan to cut most pro-vider fees $25.6 million, the DD HCB waiver budget $3.6 million (freezing-in a waiting list) & the state kidney dialysis program $250,000. ADAP’s 332% income level was cut, it has a waiting list of 17 and its program costs may be capped.   

SOURCES AND RESOURCES: 

For the 48 states & DC, the 2009 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 Assist. Secy. for Plan.& Eval. pages at www.dhhs.gov for AK & HI.

Congress  extended the 2009 FPL figures until at least May 31, 2010. The 2010 SSI rates (not including state suple-

mentary payments, or SSPs) are the same as 2009’s: $674/mo for 1 & $1,011 for 2. Email sherry.barber@ssa.gov for “State Assistance Programs for SSI Recipients, 1/09”(the latest tabulation) on state Medicaid rules for SSI recipients, state supplementary payment (SSP) amounts and states’ Section 1616, 1634 & 209(b) eligibility arrangements   

The best source for state adult income levels is “Where Are States Today? Medicaid & State-Funded Coverage Elig. Levels For…Adults” [pub. # 7993, Tables 1, 2 & 3] in the Medicaid pages at www.kff.org  

See “The State of the States, Jan. 2010” at www.statecoverage.org for a summary of coverage changes in state Medicaid, CHIP, non-federal medical assistance, insurance subsidy programs & insurance regulations. See the 50 state survey of Medicaid spending, coverage& policy in 2009-10 (Document #7985) at www.kff.org. State action on MSP (QMB, SLMB & QI) reforms is studied at www.medicarerights.org/pdf/Warning-Signs-MIPPA.pdf.  

 “Best Kept Secrets”, at www.theaccessproject.org, reports that many safety net & non-profit hospitals fail to adequately publicize & detail their indigent assistance programs---especially the eligibility income levels & application forms---as recommended by the Am. Hosp. Assoc. & now mandated by the new health reform law 

 “Many Medicaid Children…”at www.dhhs.gov/oig [a 9 state study] finds state EPSDT programs to be sub-par    

“Medicaid Expansion Now Could Save Some States Money” at www.KHN.org (4/1/10) points out that many states can add huge windfalls to their health assistance budgets by now being able to claim their regular federal Medicaid matching rates for heretofore fully state-funded medical assistance for childless, non-disabled, non-aged persons un-der 133% FPL. For policy & details on how states can do so, see CMS’ State Med. Dir. Letter # 10-005, “New Options for Coverage of Individuals Under Medicaid” (4//10/10) at  http://www.cms.gov/smdl/downloads/SMD10005.PDF 

“Medicaid Coverage & Spending in Health Reform: [State Costs & Patient Numbers] For Adults ..Below 133% FPL” at www.kff.org projects the numbers of new Medicaid patients & ongoing tiny state share of costs [under10%] &“Federal Government Will Pick Up Nearly All Costs…” at www.CBPP.org also confirms the ongoing 90%+ match        

The“2010 Pickle Instructions” at www.healthlaw.org shows how to calculate a restoration of Medicaid coverage for many persons formerly on both Social Security & SSI even if their income has since then risen over current SSI levels 

“Emergency Dept….Visits..2007”at www.nchs.gov found that the uninsured do not use ER’s more than the insured—but that Medicaid patients do (mostly because of low Medicaid fees that discourage private MD’s from seeing them).    

www.kff.org/medicaidbenefits/ lists state chiropractor, podiatry, eyeglasses, optometry, hearing aid, hospice, psycholog- ist, prosthetics, home health, medical equip, dental, Rx’s, OTC drugs & 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 & 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 the “ADAP Pill Box” periodical.    

State Rx co-pay data is in “State Medicaid Drug Reimburse. ” at www.ascp.com . See “Pharm. Benefits [in] State [Medicaid]” at www.npcnow.org on formularies, fees, OTC items, prior auth., prescribing/dispensing limits & co-pays. Email jcoburn@hdadvocates.org for chart on how drug maker PAPs mesh with Pt D. States can cover the 6 drug clas-ses excluded by Pt D with their own funds; see chart on such state coverage at www.medicareadvocacy.org (12/1/05 report at “News” icon); see Rpt. # 10-42 at www.GAO.gov, on cost-sharing, etc. of Pt D high cost/”specialty” tier drugs 

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 2009 state personal needs allowances (PNAs) for SNF & ICF patients and residents of SSP-funded board & care facilities          

See www.naschip.org on state risk pools & order “Comprehensive Health Ins. for High Risk Individuals: A State-by-State Analysis” on funding, eligibility, benefits, Medicare supplements, premiums & low income premium discounts 

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 

See ”From CANN ” in “Other Organizations’ Materials” under ”Medicaid”, below “Issues” at www.healthlaw.org for “ Painless Ways To Deal With..Medicaid Budget Shortfalls” to avoid eligibility & benefits cuts;  “State..Aged/ Dis-abled…Levels” &  “State..Parent… Levels”; a health/Medicaid  “Glossary”;  and  “2010 VA Health..Benefits”