Alabama--has no spend down, an aged/disabled level of $674 (the SSI rate), a parent level of 11%/ 24% if wkg (’11) & an ADAP level of 250%; covers 12 MD visits & hosp days/yr & only 5 brand  Rx’s/mo but has no MSP asset tests. The old legislature (D) cut HIV care $2 million but overrode a veto to raise CHIP’s 200% level to 300%. The risk pool had once planned low income premium discounts but has no Medicare supplement. There are 2,500 on the HCB waiver waiting list. Gov Bentley (R) & the legislature (both Houses are now R) face a $700 million Medicaid shortfall: so they started an ADAP waiting list (with 15 on it so far) & cut its formulary and reduced the Medicaid drug budget by $30 million

Alaska--this Title XVI state has no spend down; an aged/disabled level of $1,036/mo (its SSI/SSP rate), a parent level of 77/81% if wkg (‘11), 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. Flush with big state royalties from high oil prices, Gov. Parnell (R) & the legislature (R House; tied Senate) raised the 175% CHIP level to 200%. While  he refused US grants to plan an Exchange & better police health premium raises, he requested a $160 million budget increase---surprisingly, one-third for Medicaid!

Arizona--covers parents & childless--even non-disabled--adults under 100%/106% wkg. The CHIP level is 200% & ADAP’s is 300%. The legislature (R) killed a program to coverthe disabled during the 2 yr Medicare wait, cut MD fees & personal care funds but preserved CHIP. With a budget short billions, Gov Brewer (R) cut ADAP’s formulary, mental   health funds & home  care, ended hospice & non-emergency transport & retained a CHIP freeze that’s cut enrollment by over 10,000 with a waiting list of 40,000. She started new  and raised existing co-pays; if HHS consents, she’ll drop the spend down by July 1. She ended coverage of physicals, podiatry, most dentistry, dentures, transplants (she later partly relented), medical equip., in-sulin pumps, hearing aids, cochlear implants &computerized prostheses. HHS Sec Sibelius said she can’t legally stop ex-piration of the waiver covering 280,000 childless, non-disabled adults. (But coverage of everyone under 100% was mand-ated by a state voter referendum law & a later referendum amended the state constitution to forbid legislative repeal or not  implementing referenda-passed laws; advocates filed suit to bar the cut in the State Supreme Ct). She now says she’ll let their coverage lapse by attrition, charge the obese & smokers $50 fees, but also proposes to cut the parent income level

Arkansas—has an aged/disabled level of $674 (the SSI rate), a parent level of 13%/17% wkg (’11), 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 fund low income premium discounts. Beebe may cut the number of covered MD visits & Rx’s; did cut ADAP’s formulary & its income level from 500 to 200% (dropping 99 clients in 9/09) & now has a waiting list of 59. He needs $60-$80 million more for the FY 2012 Medicaid budget to maintain eligibility, services & provider fees; so with CMS consent, he’ll change hospital & MD payment systems from fee-for-service to a sort of mixed ACO/DRG-type model 

California-- The state covers the aged/disabled under 100% (with a $230, not just a $20, disregard), parents & prostate cancer patients below 200% (’11) %. ADAP’s level is 400% & CHIP’s is 250%. With a $19 billion deficit, ex-Gov. Schwarzenegger (R) & the legislature (D) raised premiums; capped child dental care at $1,500-$1,800/yr; cut podiatry & psychiatric benefits; denied non-emergency care to legal aliens & cut provider fees. A $2.75 billion cut dropped 3 million adults. He denied ADAP to county jail inmates & proposed a lower parent level, ending home health care & personal aides for the disabled & cutting low income clinic funds. Gov Brown (D) plans to sign bills reducing “non-life-saving” Rx coverage to 6/mo, MD visits to 7/yr ; charging $50 ER, $5 MD & $100 hospitalization co-pays; and cutting MD fees 10% A $300 million 2011 LA Co. Health Dept. shortfall may cut patients served by 1/4  to 1/2. Courts barred ending adult pod-iatry, chiropractic & dental care before first getting CMS consent. The legislature cut home care & DD & mental health funds. Brown added $77 million to ADAP, is starting a state Health Exchange & plans to add county medical assistance patients (childless, non-disabled legal resident adults) to US-matched Medicaid, as allowed by the US health reform law 

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% (but a waiting list may be needed soon). The risk pool has low in-come premium discounts for those below $50,000 & Medicare supplements. Ex-Gov Ritter (D) began a formulary, made health plans cover PTSD, anorexia, sub-stance abuse & colorectal screening. but cut ADAP’s formulary. Medicaid’s case-load is up 200,00 since ‘01, but he & the old legislature (D) passed a $600 million hospital tax for Medicaid, CHIP & the state indigent health program; boost hospital rates & uncompensated care funds; and cover 100,000 more persons by rais-ing all adult levels to 100% (it already covers parents & by 2012 will also cover childless, non- disabled adults too) with new US health reform matching; applied the mini-COBRA law to small firms; raised CHIP’s level from 205 to 250% & widened its psychiatric care; planned to offer Medicaid to the working disabled starting 7/1/11, began a SPAP for HIV cli-ents; covered legal aliens; set a 300% level for nursing home & HCB waivers (with liberal HCB & personal aide features & with some patient autonomy). Advocates for disabled children say the 300% FOA level is too low to reach enough  such children; that their Medicaid premiums are too high; and that the state still rations how many cases can be covered. The state let HMOs sell cheap policies to the uninsured--but cut funds for DD & disabled client employment, transport & personal aide pay & may start an ADAP wait list. Gov Hickenlooper & the Senate (both D), who campaigned for health expansion, plan instead to cut services $13 million, with likely help from a bare 1-vote new GOP House majority

Connecticut—is a 209(b) state with 2-zone aged/disabled levels ($786.22 & $894.61, its SSI/SSP rates for those with at least $400/mo shelter costs, and a $278 disregard). Its parent level is 185%/191% wkg {’11); ADAP’s  is 400%; CHIP’s is 300%; and its risk pool has a low income premium discount for those under 200% & a Medicare supplement. Ex-Gov. Rell (R) ended SPAP coverage of Pt D non-formulary Rx’s (but still covered Pt D-excluded Rx’s); yet there’s no MSP as-set test & SPAP income levels are $25,100 for 1; $33,800 for 2). She limited adult chiropractor, naturopath, psychologist  and occu, physical & speech therapy coverage to clinics; but extended hospice care to all Medicaid patients. The legisla-ture (D) covered the wkg disabled. Rell wanted to force patients back into HMOs to fund the skimpy, subsidized “Charter Oak” insurance plan she set up for parents under 306% & other adults under 310%. With premiums up 72% since 1/10, it has big co-pays, limited psychiatric care, low caps on Rx’s, medical equipment & total yearly costs and a $1 million life-time cap--yet its costs may force a close in enrollment. CMS provides US matching to give Medicaid to childless non-disabled adults under 56% who were eligible for state Gen Med Asst (even keeping its $150/mo  earnings disregard), ex-tended COBRA to 30 mos, and raised QMB’s income level to 207%+, SLMB’s to 227%+ & QI’s to 242%+ (giving most SPAP clients full Part D Extra Help too). 2011’s deficit is $263 million. Gov Malloy (D) is considering merging Medicaid & public worker health plans, is moving 2,200 nursing home patients into home or HCB care, will cancel CHIP & Charter Oak managed care contracts, but cut adult dental coverage & reduced low income clinic funding by $3.8 million.

Delaware---has no spend down; covers parents under 100%/120% if wkg & all other adults under 100%/110% if wkg; 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 even let over-income children buy into CHIP at full price. 

District of Columbia---has parent levels of 200%/207% if wkg, 100% for aged & disabled, 300% for CHIP & 400% for ADAP. DC’s own non-federal medical assistance covers others under 200%/211% if wkg. Ex-Mayor Fenty & the Council (both D) covered adult dentistry; raised the QMB level to 300%  & dropped its asset test (thus giving many DC Medicare patients full Pt D Extra Help). But he proposed replacing public mental health clinic care with private contractor services & cutting funds for low income clinics, revoked DC’s just-raised MD fees for dual eligibles and cut home care & funding for the disabled’s personal aides. DC Medicaid was extended in 12/10 to childless, non-disabled legal residents under 133 or 200% who’d been on local medical assistance, using new US health reform matching. DC is keeping the safety net, debt-ridden United Med Ctr (formerly Greater SE Hosp) open after acquiring it at a public auction. CMS says DC—facing a $600 million 2 yr deficit—owes it $58 million for over-claimed 2004-05 matching, which Mayor Gray (D) disputes. 

Florida---The legislature (R) got a waiver to move patients (a court order has so far let them opt out) into for-profit man-aged care; but it’s so far done so in only 5 counties. Yet it’s still begun expanding the waiver into other counties (starting with the aged & disabled, and then adding non-disabled parents & children only later) even though its request to extend & expand the waiver doesn’t yet have final CMS approval. Yet the legislature & Gov. Scott (both R) not only want to ex-pand managed care, they plan to cut MD fees, slash Medicaid costs $1.8 billion, make almost all Medicaid patients each pay $10/mo premiums & charge them $100 co-pays for non-emergency ER visits. The under-funded, often-closed pre-health reform state risk pool has a Medicare supplement but no low income premium discount. The state cut the aged & disabled level from 88% to SSI’s $674/mo  rate, except for those in HCB waivers or in Medicare’s 2 yr disabled waiting period. The parent level is 20%/59% wkg (‘11).. The state covers dentures (but little other adult dentistry) & hearing aids. Ex-Gov Crist (I) dropped Zyprexa & Invesa Sustena from the formulary, made private plans cover autism care, gutted the insurance minimum benefits law& fostered cheap policies for the uninsured (see www.coverfloridahealthcare.com; start-up may be delayed until late 2011 since its policies may not meet US health reform insurance rules without a waiver). Blue Cross & the Dade Co. Health Dept sponsor cheap ($105/mo for 1 under 250%), but lean, “Miami-Dade Blue” poli-cies with no brand name Rx benefit. Crist dropped hospice coverage; cut dialysis, mental health & substance abuse funds; and reduced MD fees. There are 19,000 on HCB & home care waiting lists, so to settle a suit Crist agreed to spend $27 million more on HCB waivers. Advocates say that isn’t nearly enough with such a backlog & filed a class action suit ag-ainst the state. Crist raised cigarette taxes $1 to yield $1 billion (much for Medicaid), vetoed nursing home & DD care fee cuts; and made insurers sell Medigap policies almost as fairly to the disabled as to the aged. Miami’s Jackson  Mem  Hosp again faces rising deficits, is closing 2 O/P clinics & 2 transplant units; and ending dialysis for 175 indigents (many are illegal aliens). ADAP cut its formulary & has a waiting list of 3,938 (even though 5,403 were transferred to the private Wellvista charity HIV Rx program), to which 1,000 more may be added.  The HIV premium assistance level is 400% & neither it nor ADAP have asset tests. ADAP is short $1.5 million even after it got $1 million from other HIV accounts; the premium payment program has its own waiting list of over 260 and ADAP’s level was cut to 200%. Funding shortfalls forced Jacksonville to close 3 low income clinics. Scott made a 15% cut in funds for DD facilities & their services staffs 

Georgia---Its aged/disabled level is $674/mo (the SSI rate), its parent level is 28%/50% if wkg (‘11), ADAP’s is 300% & CHIP’s is 235%. It has a monthly numerical cap on Rx’s; dropped CHIP dental surgery coverage & raised its premiums;ended routine adult dental & artificial limb benefits & nursing home spend downs; and narrowed Katie Beckett waiver ad-mission rules. Ex-Gov Perdue & the legislature (both R) herded patients into HMOs, but allow opt outs. Atlanta’s Grady Hosp, with a $6 million deficit from indigent care costs, closed its dialysis center (but arranged continued care for indigent illegal alien patients) & 3 of its 9 O/P clinics and cut its free care level to 125 from 250%. With 2011’s $506 million Med-icaid shortfall, Perdue wouldn’t  raise provider fees & cut ADAP $1.2 million. He’d hoped to get a hospital bed tax (with proceeds used to attract more matching), but MD & DDS fees will be cut anyway; sought more insurance taxes & fines to pay health costs, closed a mental hospital building, cut pregnancy & infant care funds; imposed ADAP medical criteria (it’s waiting list is 1,520) & proposed privatizing some mental health care. Gov Deal (R) wants even more cuts (i.e., end-ing adult podiatry, vision & emergency dentistry). but the House voted to retain them. Yet he still wants to raise adult O/P care co-pays to 15%. their I/P hospital co-pays by a whopping 400% & even impose co-pays on children for the first time.  

Hawaii—this 209(b) state gave limited Medicaid benefits to all adults below 200% (even the childless & non-disabled), but just lowered that income level to 133% (dropping 4,500+ patients), but only parents & the aged & disabled under 100% get full Medicaid. Its ADAP level is 400%. & it covers the wkg disabled. Ex-Gov. Lingle (R) and the legislature (D) raised CHIP’s level to 300%, ended its premiums & let richer children buy into it at full price. With an $86 million 2011 shortfall, Lingle began moving 37,000 aged & disabled into managed care, ended non-emergency adult dentistry & planned cuts for non-pregnant & non-disabled adults. Gov Abercrombie (D) favors health expansion & is establishing a voluntary-for-providers “medical home model” in Medicaid,  but had to cut  Medicaid $25 million for FY ’12; $50 mil-lion for FY ’13; and limit non-disabled, non-aged adults to 20 MD visits/yr, 10 I/P hospital days/yr & 3 O/P surgeries/yr

Idaho--is a Title XVI state, with no spend down, an aged/disabled level of $727 (the SSI/SSP rate), a parent level of 21%/ 39% if wkg (‘11) & a 200% ADAP level. The legislature (R) raised the CHIP level from 150 to 185%; funds a pilot plan for small firm workers under 185%, covered the wkg disabled & sorted clients into 3 groups: Parents & children; disabled & chronic cases; and the aged. Each may get differing benefits or co-pays but more preventive care. Gov. Otter (R) charg-es 4% of income premiums to Katie Becket cases. The deficit is $86 million+ & he may charge all disabled children extra premiums; and cut hosp, MD, rehab facility & DD agency fees (which a court voided temporarily) and occu & speech the-rapy & autism care funds; and started an ADAP waiting list (it’s now 14). He & the legislature plan 2012 Medicaid cuts of $34 million: more & higher co-pays; lower Rx fees; and audiology, vision, podiatry & mental health cuts; limiting adult dental care to extractions & pain emergencies; moving more patients into managed care; and imposing a $7.5 million “assessment” on hospitals & nursing homes. The House voted to end a cystic fibrosis program & non-emergency transport 

Illinois--this 209(b) state’s aged/disabled level is 100% (with a $25, not just a $20, disregard).Its main SPAP excludes the disabled not yet on Medicare, who get only a very limited formulary from a 2^nd SPAP. Both SPAPs’ income levels are;  $27,600 for 1, $36,635 for 2, etc. The legislature (D) raised the parent level to 185%, accepted a court order to raise pedia-tric fees. Yet other fees are too low & paid very late, with such a gigantic unpaid claims backlog that Gov. Quinn {D} proposes to borrow billions more--which, with US matching, would fund a big start in paying it down) ; the state also raised CHIP’s level 200 to 300%. The often-closed state risk pool has a Medicare supplement but no low income prem-ium discount (yet the new, separate US health reform-funded  risk pool’s premiums are affordable for many under age 40, and can be co-ordinated with ADAP and/or Part D). The state 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 & the U of IL at Chi-cago closed a clinic too. The state gave $640 million to safety net hospitals, made hospitals give the uninsured discounts & imposed an “assessment” on them to attract $450 million more in US matching. With a $13+ billion deficit, the legislature gave Quinn authority to cut the budget ($500 million+ in human services cuts, even in community mental health, are likely), and it raised the 3% state income tax by 2.25%); required better income verification by applicants; forced more patients into “medical homes” with managed care, cut hospital & nursing home rates 6%; and denied CHIP to children with income over 300%. He hopes to save $400 million more with case management for the aged & disabled (38,000 of whom are already on HCB waiting lists) & did give ADAP enough of a raise to serve 4,500 more clients (although there’s now a $2,000 per patient spending cap per month), but a $3 million budget cut requires lowering ADAP’s  income level from 500 to 300% on July 1, 2011.  The budget also calls for abolishing one or both SPAPs. 

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 (‘11). Gov. Daniels & the legislature (then R & now again all-R) 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 denture replacement & re-lining limit (and the legislature is now considering a once-every-5-years eyeglasses replacement limit). ADAP (with a 300% level) may have to start a waiting list & 21,000 DD clients are already on a HCB waiver waiting list, but Daniels did raise the CHIP level from 200 to 300%. A waiver subsidizes coverage for parents bel-ow 200% & even has 42,000 slots for the childless, non-disabled under 65 (with 52,000 more on a waiting list when he closed enrollment). He opposed the US health reform bill, but now seeks to extend the waiver & then use newly-available US health reform matching to cover all non-aged adults under 133% by--or even before--2014 (but only if HSAs are al-lowed). Waiver coverage uses HMOs; has few co-pays & no dental, vision or maternity care; patients must put 2%-5% of income into HSAs,  pay near-unaffordable premiums & meet $1100/yr in cost-sharing; it has $300,000/yr & $1 million lifetime coverage caps. Daniels plans to cut hospital, nursing home & other provider fees 5%. The state Supreme Ct  re-jected a suit to make the state consider more possible impairments in Medicaid disability determinations. Budget cuts will end or limit adult dental, vision, chiropractic & podiatry coverage & Daniels plans to cut the mental health Rx formulary 

Iowa--A waiver covers both O/P & emergency I/P care for non-Medicare adults (even if childless & non-disabled) under 200%/250% if wkg at any Iowa public or low income clinic or hospital.But Rx’s “to go” & elective I/P hospitalizations are offered only at 2 safety net hospitals in Des Moines & Iowa City. The aged/disabled level is $674/mo (the SSI rate), the parent level is 28%/ 83% if working (‘11) & ADAP’s  is 200%. The risk pool has a Medicare supplement but no low income premium discount. Medicaid faces a $600 million shortfall. Ex-Gov. Culver & the old legislature (both D) cover-ed disabled children under 300% via the FOA, raised CHIP’s  level from 200 to 300% & let children with no dental cov- erage buy into CHIP dental benefits. The hospitals proposed taxing themselves $40 million to attract added US matching funds to raise their rates & meet other rising costs. ADAP program costs were capped on 9/15-- and there’d even briefly been a waiting list. Gov Branstad & the new House (both R) plan to make Medicaid cuts (such as ending chiropractic cov-erage, raising co-pays & requiring pre-authorization for more types of care), but the state Senate (still D) must agree  too. 

Kansas---this Title XVI state has an aged/disabled level of $674/mo (the SSI rate), a parent level of 26%/32% wkg (‘11), a 200% CHIP level & a 300% ADAP level. Its GOP legislature, covered the wkg disabled, offered state mini-COBRA rights, and raised CHIP’s level to 250%. There are 5,700 on wait-ing lists for services for phys disabled & DD clients, yet it cut home care fun-ding for the aged & disabled; put 6,000 more on waiting lists for HCB & home care; cut MD fees & disabled clients’ care-givers’ pay, ended welfare for 1,500 awaiting SSA disability awards; denied dental care to poor wo-men; raised CHIP premiums to $20/mo; and froze admissions to state mental hospitals. Ex- Gov. Parkinson (D) sought to have case managers oversee psychiatric Rx therapy and to require more pre-authorizations, charge co-pays for “unneces-sary” ER visits & close state DD facility to new admissions. Gov. Brownback (R) wants even more health cuts: He order-ed Aging Dept employee costs slashed 1/4, cut mental health funds $25 million, ended funds for community mental health centers, proposed ending mental health services for 850 families with emotionally ill children & told his Lt. Gov. to make Medicaid cuts of $200 to $400 million yearly by 2013 (probably by forcing the aged & disabled into managed care).    .

Kentucky--- has an aged/disabled level of $674/mo (the SSI rate), a parent level of 36%/62% if working (‘11), a 200% CHIP level & a 300% ADAP level. The legislature (R Sen.; D House) dropped tough, 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. Beshear (D) faces an impending Medicaid/CHIP shortfall of up to $500 million. His Medicaid cost control committee offered few new solutions. He enrolled 22,000 more children in CHIP & dropped its $20/mo pre-mium. By 9/10 ADAP was able to cover the 227 from its waiting list with other funds & program economies, but co-pays & formulary cuts remain in place. After the Senate (R) got the House (D) to join it to reject Beshear’s  plan to avert cuts by pre-spending $167 million this year of the next biennial budget’s Medicaid funds--and instead fund the current shortfall with cuts to education & other programs---he line-item vetoed their bill (and an over-ride attempt failed). This now lets him unilaterally implement his own Medicaid budget plan---centering on much more use of managed care to save money. 

Louisiana---has an aged/disabled level of $674/mo (the SSI rate), a parent level of 11%/25% wkg (‘11) & a 300% ADAP level. The legislature (newly R-House; nominally D-Sen) voted to raise the CHIP 250% level to 300% but can’t afford to. Gov Jindal (R) covered the wkg disabled & got CMS to agree to a state refund of only $266 million of past overpayments When a $30 million /yr US primary clinic grant wasn’t renewed, he found other money for it & CMS even let him spend $97.3 million in US Medicaid hospital funds on primary care clinics. He plans to save $268 million cutting covered Rx’s from 8 to 5 mo (unless more are “medically justified”); MD & hospital rates and privatizing community services & HCB waiver care for the aged, CMI, DD & phys disabled. He delayed & may drop plans to put clients into PPOs & HMOs. US matching fell $700 million in 2011 & 2012’s deficit’s $1.5 billion. Yet he somehow got the US to commit to $400 million more for health care. FEMA will pay $478 million to rebuild the N. O. Charity Hosp & the state will add $300 million but it must also find $70-$100 million/yr more for operating costs. Yet Jindal wants a $62 million cut for LSU’s Hospitals ev-en though he already lacks enough funds to run 4 to 6 LSU & Charity Hospitals as it is. ADAP’s $11.7 million deficit re-quired shifting $2 million of other HIV funds to it, but there’s still a waiting list of 696. The House approved cutting Me-dicaid provider fees 8% and & managed care costs $81 to $91 million— cuts that even Jindal wants the Senate to lessen.

Maine—The state, until now,  had these income levels: subsidized insurance, 300% ; the aged & disabled, 100% (with a $75, not just a $20, disregard for Medicaid & the MSPs); childless, non-disabled adults, 100% (via a Medicaids waiver that had only just started taking 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 an O/P-only waiver care for HIV+ (even “pre-disabled”) patients. There’s no risk pool. Adults get dentures but little other dental care. There are no MSP asset tests and QMB’s income level is 150%, SLMB’s, 170% & QI’s, 185%. With a $100 million 2011 deficit, the state raised cost-sharing for those over 150%, cut podiatry care & provider fees and  may start an ADAP waiting list .Gov LePage (R) & the new legislature (both Houses are now R) were expected to make big health cuts, yet at first joined Democrats to pay hospitals $70 million in past-due bills (but then a later re-audit of billings showed that, in fact, the hospitals had actually been overpaid  that same amount) & even to add $73 million more to the coming year’s Medicaid budget (for which even more may now be needed because CMS auditors now suspect the state over-claimed $150 million in past US matching). Now LePage plans to drop 16,000-–even though there’s 14,000 more on its waiting list—of the childless, non-disabled  from the waiver (which he claims is a voluntary state add-on & thus needs no HHS approval to be dropped & isn’t subject to the US laws’ maintenance-of-effort rules), and even drop 12,000 parents by cutting their 200% Medicaid income level to 133% 

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 non-Medicare adults (even if childless & non-disabled) under 116% (128% for the latter if wkg). 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 Baltimore’s  state dental school & Prince Georges Co. started indigent child dental clinics. The risk pool has low income premium dis-counts for those under 200%, but no Medicare supplement. Gov O’Malley & the legislature (both D) covered the wkg dis-abled, raised the parent level to 116% for full Medicaid & subsidize insurance for some low paid small firm workers. He cut $82 million in nursing home, home health aide, private RN & HMO fees & slashed hospital rates to 80% of private plans’. A $389 million 2011 deficit forced him to delay a 2^nd expansion of full Medicaid to childless, non-disabled adults under 116% --but then he said he’ll now do so with newly-available US health reform matching  He again cut providers’, HMOs’, HCB programs’ & the disabled’s personal aide fees & plans more cuts---even closing a mental hospital. He & the nursing homes hope to more than make up their fee cuts with later rate increases funded by a 2% tax they’ll pay to use to attract more US matching. With a $1.2 billion 2012 deficit, he’s considering a $150-$264 million hospital “assessment” to attract more matching with which to raise their rates too & meet other rising Medicaid costs. He’s raising child dental fees carving child dentistry out of HMO contracts to be directly state-run & 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 (which some say 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 I/P hospital days to 20; and requiring college students to be insured. He seeks $331 million in US funds to prop up 7 safety net hospitals; and Cambridge Hosp,, Boston Med Ctr,  St. Elizabeth & Carney hospitals face shortfalls too. The legislature is considering forcing aged dual eligibles into HMOs. To better control costs, Patrick is exploring a gradual shift to Accountable Care Organizations (ACOs) that pay for well-ness & treatment results instead of for the traditional fees-for-services that’s now driving costs above sustainability; he also ordered a 3% cut in the mental health budget, including $16.4 million for facilities, closing 160 mental hospital beds.  

Michigan---has a 100% aged/disabled level a parent level of 37%/64% wkg (‘11), a 200% CHIP level & a 450% ADAP level. It ended adult hearing aid & chiropractic coverage & briefly closed--but ex-Gov. Granholm (D) later re-opened its O/P care-only waiver for childless, non-disabled adults under 35%/45% wkg. The legislature raised co-pays but boosted child wellness, dental & adult preventive fees. The Lansing, Muskegon, Detroit & Flint-area counties offer free or cheap coverage to those under 200% (but F lint’s Genesee Co. had to impose a 2 month waiting period on new applicants & may have to turn away additional new ones). With a $480 million 2012 deficit, the House (once D, but now R) & Senate (still R) briefly ended adult vision care, but then the legislature’s budget restored adult dental, vision & podiatry (but not hear-ing aid or chiropractic) care & avoids MD, hospital & most mental health cuts. Gov Snyder (R) favors preventive care & pledged to (and made) no regular provider fee cuts--but then cut teaching hospitals $67 million & general Medicaid agen-cy costs $21 million; and began forcing dual eligibles into cheaper HMOs. The US-funded risk pool cut its premiums ($103 to $415/mo by age band), but to do so had to raise deductibles (up to $3,000) & co-pays to $10, $20, $50 & $100.    

Minnesota---this 209(b) state has an aged/disabled level of 100%, a regular, full Medicaid parent level of 215%/219% if wkg (‘11), 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 $5 billion 2012 deficit, ex-Gov. Pawlenty (R) raised premiums & co-pays for Medicaid , CHIP & MinnesotaCare (state-subsidized insurance for parents under 275% & childless, non-disabled ad-ults below 250%) and denied Medicaid & CHIP to legal aliens. He capped enrollment in HCB care and tightened medical qualifications & cut paid hours for home aides; cut nursing home & HCB waiver fees; raised some premiums; ended cov-erage of occu & speech therapy, audiology & adult dentistry. Hennepin Co. Med Ctr can’t afford to keep giving free care to other counties’ indigents & had to cut dental, mental health & HIV care. As authorized by the outgoing legislature (D) & the US health reform law, Gov Dayton (D) expanded US-matched Medicaid to cover previously 100% state-funded General Medical Assistance (GMA) patients. Previously, 18,000 non-Twin Cities GMA patients had no regular providers at all & even those seen at the 4 Twin Cities hospitals that did take GMA patients had long waits for primary care & long-er waits for specialists. Some hospitals & managed care plans propose to cut the deficit 33% by forcing the disabled into HMOs. Dayton wants small nursing home & HCB fee cuts & a low nursing home tax, with much of the proceeds to be used to attract more US matching to raise rates. The new GOP legislative majority proposes to drop the 100,000 GMA & other patients Dayton added to Medicaid, plus 7,200 more from MinnesotaCare; give some or all clients $240/mo vouch- ers to buy private insurance instead; and cut MD & HMO fees and services for the aged & disabled each by $300 million  

Mississippi---has no spend down. Gov. Barbour (R) cut the aged/disabled level from $1,000+ to $724/mo (with a $50, not just a $20, disregard) & there are no MSP asset tests. The parent level is 24%/44% wkg (‘11), CHIP’s is 200% & ADAP’s  is 400% (which may be cut to 200%). Only 2 brand Rx’s/mo & 3 generics/mo are covered (but 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 (now tied) won’t drop it, except maybe for LTC, but the House (nominally D) might. After securing new cigarette & hosp taxes, Barbour proposed DDS, nursing home & hospital (but not MD) fee cuts, as well as patient premiums & big-ger co-pays; proposes a 7% mental health cut, lower mental health center subsidies and closing 4 mental hospitals & 15 mental crisis centers. He won’t use state reserve funds or even enhanced US matching funds to bolster Medicaid (it’s 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% wkg (‘11); en-ded 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 level (which covers the aged and disabled on Medicare) to 150%. The SPAP law sunsets in 8/11, but Gov. Nixon (D) is cam-paigning across the state to get the legislature (still R) to extend it for 5 years. Blue Cross & a foundation subsidize insur-ance for KC-area families under $30,000. The state pays “premium support” for clients’ job plan premiums but then den-ies them full Medicaid for secondary coverage; restored hospice & working disabled coverage (but the latter covers only those with very low SSDI checks); offers birth control & screenings to women under 185%; restored adult vision (except  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 closing CHIP cases. The state let community health centers & rural clinics presumptively enroll children in Medicaid & CHIP (before, only 4 hospitals could do so).Nixon asked the legislature to partially restore the 100% parent level (only to 50%); cover all adult dental & vision care; and liberalize CHIP premiums & coverage (but it spurned all 3 proposals). Caseload growth forced him to drop plans to restore the 100% aged & disa-bled level & do more outreach (in fact, new red tape now impedes enrollment). He sought cuts of $139 million in hospital rates & $32 million in MD & DDS fees & in mental health & public clinic funding; and cut ADAP’s formulary. The state made private plans cover some autism care. CMS said the state wrongly limits home health benefit to the homebound. 

Montana---has an aged/disabled level of $674/mo (the SSI rate), a parent level of 32%/56% if wkg (‘11), an ADAP level of 330% & a risk pool with low income premium discounts for those under 150% & a Medicare supplement. With a $200+ million deficit, 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 26); seek a waiver to cover more adults; raised the family asset level; set up a SPAP for aged (but not disabled) Medicare 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 and Schweitzer appears ready to agree to the GOP legislature’s 6% provider fee reduction. 

Nebraska---is a Title XVI state with a one-house legislature. Its aged/disabled level is 100%, its parent level is 47%/58% if wkg (‘11) & 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 supple-ment 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 reimbursements 5% ($68 million), raised patient co-pays & may limit dental care to $1,000/yr, hearing aids to 1 ea 4 yrs, eyeglasses to 1 ea 2 yrs & adults to 12 chiropractic visits & 60 occu, speech & phys therapy sessions/yr. ADAP’s formulary was cut too. When the state Medicaid program dropped pregnant aliens (even legal ones), over 1,500 untreated cases resulted in needless & costly pre-mature births or still-borns—even though the U of NE Med Ctr offered to cover them in its own indigent program. The legislature is now reconsidering that cut. It did widen school health services. Hein-eman wants to deny Medicaid to welfare recipients who don’t meet his work requirements. The legislature overrode his veto of the nursing homes’ plan to tax themselves enough to attract more US matching with which to then raise their rates. 

Nevada---a Title XVI state with no spend down; its disabled level is $674/mo (the SSI-only rate), but the aged-only level is $710.40 (their own higher SSI/SSP rate); its parent level is 25%/88% wkg (‘11); its CHIP level is 200%; its ADAP lev-el is 400%. It subsidizes insurance for parents under 200% working in participating small firms & covers the wkg disab-led. 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 state capped CHIP dentistry at $600/yr; ended Medicaid adult dental & vision care, CHIP orthodontia; tightened SNF, ICF, HCB waiver & home care medical eligibility rules; and cut pregnancy coverage, hospital rates (closing the U of NV.at LV Hosp’s dialysis & oncology units) & HCB waiver fees; dropped attendant pay-ments for the disabled; and cut non-emergency transport, and hospital neonatal, HCB & pediatric specialist fees. The LV-area HIV budget was cut $1 million, and many new indigents seeking care at low income clinics are causing them big budget shortfalls. The state set up a formulary of antipsychotic, anticonvulsant & diabetic Rx’s. Gov Sandoval (R) prop-osed a $200 million cut in the current budget & a $500 million cut in the 2013-14 budget--reducing Rx benefits $104 mil-lion (offering no details yet), cutting O/P mental health care $60 million & other provider fees by 15 to 43%. But the leg-islature’s (still D) relevant committees rejected $88 million in nursing home, hospital & MD fee cuts by party-line votes and some hospitals & Democrats proposed more & higher business taxes as better funding alternatives to meet shortfalls. 

New Hampshire---a 209(b) state; its risk pool has no Medicare supplement but has low income premium discounts for those under 250%. Its aged/disabled level is $674 (the SSI rate, with a disregard of just $13, not $20/mo). The parent level is 39%/49% wkg (‘11); the CHIP & ADAP levels are 300%. It has a much-stricter-than-SSI “209(b)” Medicaid disability rule (inability to work for over 4 yrs) & doesn’t cover hospices. Gov. Lynch (D) & the legislature (then D; now R) shifted LTC costs to counties, ended a DD care waiting list & will make more cuts in hospital, MD, LTC & mental health fees (2011-2’s deficit is $75 million). US auditors want $35 million in over-claimed DSH funds back. Lynch & GOP legisla-tors back a bill to force most patients into HMOs. The legislature cut hospital fees $250 million & even repealed a hospit-al tax that had yielded enough funds to attract added US matching to bolster their own & other Medicaid fees for 20 years 

New Jersey---has an aged/disabled level of 100%; a 500% ADAP level (but GOP Gov. Christie cut the formulary for cli-ents over 300%) & SPAP levels of $31,850 for 1 & $36,791 for 2. A new waiver adds coverage of  up to 70,000 childless, non-disabled adults with income under $140/mo. The legislature (D) raised the parent level to 200% & ended CHIP prem-iums for those below 200%.  The state cut hospital charity & teaching funds, raised SPAP co-pays and cut its formulary. Christie seeks to drop coverage of legal aliens, township indigent care funding & coverage of parents over 133% ( but the Wall Street Journal reports his proposed new lower parent level to be only 25% to 29%). The legislature (still D) opposes his $3 adult day-care co-pay proposal and ending the state’s Pt D wraparound, Pt D co-pay aid & other Pt D supplements. He still refuses US birth control, obstetrics and cervical & breast cancer screening funds and vetoed a family planning bill. He plans to meet a $10+ billion deficit by higher cost-sharing; cutting nursing home fees; and seeks a 2^nd “comprehensive” waiver to “save” $300 million.  It’s unclear what that waiver will do. He also plans $240 million in savings by forcing the rest of the aged & disabled (many are still in fee-for-service coverage) into Medicaid managed care plans and even by handling their pharmacy, home health, medical day care and personal attendant assistance through managed care too 

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 (‘11), CHIP’s is 235% & ADAP’s is 400%. A waiver—which is again closed to new individual applicants, but not to small employer groups---subsidizes insurance of any adult (even if childless or non-disabled) under 200%/250% if wkg. The state refuses to process disability-based Medicaid-only applications from those whose disability hasn’t yet been approved by SSA---no matter how much they need medical care. Medicaid’s 2011 shortfall was, as expected, $300 million+, so ex-Gov Richard-son & the legislature (both D) dropped  eligibility expansion plans. The state  may have to end adult dental, vision, hear-ing aid & hospice coverage;  slash phys, occu & speech therapy; cut mental health & substance abuse care & fees; and may cut some Rx coverage & HCB waiver care. Gov. Martinez’ (R) expected health cuts are likely to be even deeper, and she hired--without the legislature’s (still D) consent---2 consulting firms to advise her how to cut Medicaid’s budget. 

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 $761/mo for childless aged singles). ADAP’s level is 431% & CHIP’s is 400%. The state subsidizes insurance for workers under 250%, but caps Rx’s at $3,000/yr. The legislature (D House; R Sen) still excludes the disabled from EPIC (NY’s 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 and  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); it lets providers deny servi-ces to those who don’t meet co-pays; funded HIV day health care; covered colon & prostate cancer patients & wkg disab-led below 250%; required hospital discounts for those under 300% & banned taking debtors’ homes; and  passed mental health parity. With a $12+ billion 2011-12 deficit, ex-Gov. Paterson (D) made a $1 billion hospital & nursing home fee cut; started a discount Rx plan for the disabled; raised all Medicaid asset levels ($13,050 for 1, $19,200 for 2, etc); ended MSP & SPAP asset tests; and extended COBRA to 36 mos; proposed a $65 million group home cut (but then a court or- dered 4,300 mentally ill to be moved into smaller, better facilities) and signed a bill with $775 million in health cuts aimed at saving $300 million more in each future year, pares $72 million from low income health programs & makes big hospi-tal fee cuts. Short $316 million, NYC’s  public hospitals plan to cut child mental health & Rx benefits & close some clin-ics. NYC proposed to end a school dental program & cut its HIV services $17 million. The city de-funded a health insur-rance advocacy office & the safety net St. Vincent Hosp. closed. Paterson had proposed cutting NYC public hospital sub-sidies $370 million & Mayor Bloomberg wants to cut 182 school nurse jobs. Gov Cuomo (D) got the legislature to pass $1 to $2.8 billion in Medicaid & SPAP cuts & will force all Medicaid patents into HMOs  A summary of the many very complex cuts is in “Medicaid & EPIC Cutbacks..” at http://www.selfhelp.net/  (or email agrotsky@selfhelp.net). Also, a mind-boggling, extremely-detailed set of charts set forth the income & asset eligibility levels and disregards, by family size, for all the various health assistance programs at  www.newyorkhealthaccess.org  (except for the state-subsidized insurance for workers under 250% and the premiums, co-pays & benefits of the US health reform-funded risk pool).   

North Carolina---covers the wkg disabled, but allows only 8 Rx’s/mo (plus another 3 or more on an exception basis).Its aged/disabled level is 100%; its parent level is 36%/49% if wkg (‘11) & its CHIP level is 200% (the deficit now  prevents raising it). Its aged-only SPAP was suspended in 2010, but may be re-activated in 2011. The legislature (once D, but now R) created a 2 ^nd SPAP just for ADAP clients on Medicare under 175% but ineligible for Pt D full Extra Help & passed li-mited 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 does have low income premium discounts.  Gov. Per-due (D) seeks $30 million in drug maker rebates with a preferred Rx list (she later added some psychiatric Rx’s to it); pro-posed closing 50 state mental hospital beds & cutting MD, hospital, personal aide (plus limiting aide care to 18 hrs/ wk), adult dentistry, maternal care, mental health & community mental health funds (the last by $210 million). The budget cut audiology, speech, phys & occu therapy & hospice funding and ADAP by $3 million, a formulary that limits coverage to Tier 1 Rx’s & a cut in ADAP’s income level from 300 to 125%). It ends Medicaid’s HIV case manager program & cover-age of community-based rehab care and many child dental X-rays & sealants; limits breast surgery; covers diabetic items at only 1 provider; and requires prior approval of X-rays, MRIs, MRAs, PET scans, ultrasounds & some EPSDT services.  The state found $14.1 million more for ADAP, cutting its waiting list to “only” 242. The hospitals got the legislature to tax them over $200 million/yr to attract more US matching to raise their rates & meet other Medicaid costs, but it’s consi-dering ending coverage of adult insulin. nicotine gum, eye exams, dentistry, and most podiatry and chiropractic services 

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 wkg (‘11) but ADAP’s level was cut from 400 to 300%. It cov-ered disabled children under only 200% via the FOA, boosted CHIP’s level to 150% & raised the medically needy/spend down level to $750 for 1 person/mo. But the legislature (R) refused to again raise CHIP’s level (to 200%), cut ADAP’s formulary, capped enrollment & yearly costs & limited patient access to Fuzeon. Gov Dalrymple (R) plans even more cuts  

Ohio--this 209(b) state has a parent level of 90% and cut the ADAP level from 500 to 300% (dis-enrolling 257 clients, triggering a waiting list of 413 and possibly denying eligibility to 861 more with CD4 counts over 500 if their CD4 counts haven’t ever fallen below 200). Then ex-Gov. Strickland (D) shifted $12.8 million in new US Medicaid funds to ADAP to help ease--but not fully overcome--the cuts. Ohio cut its secondary fees for dual eligibles & medical assistance for those awaiting SSA disability awards; moved most patients into HMOs (some with too few specialists); but required private plan mental health parity. Its aged/disabled level is still only $589/mo (the US’ very lowest). Strickland & the old legis-lature (R-Sen; D- House) raised CHIP’s level from 200 to 300% & covered disabled children under 500% via the FOA. He got a waiver to cover assisted living & let over-income children buy into CHIP. He cut nursing home fees (but the leg-islature then partially restored them & boosted home care benefits); can’t afford to cover digital hearing aids until 7/11; cut Rx fees & community mental health funds; imposed Rx co-pays & a generics preference rule; delayed MD fee raises but restored adult dental & vision care. He told nursing homes to pay for their own patients’ phys therapy, wheelchairs & medical equip (which some can’t or won’t cover, so some patients may just do without). He moved 592 from waiting lists into HCB waiver care & imposed $718 million in fees on hospitals (with proceeds to be used to attract more matching with which to raise rates) & applied state mini-COBRA rights to small firms. Gov. Kasich & the new legislature (both R) plan a $1.4 billion biennial Medicaid cut: forcing disabled children, the mentally ill, nursing home & HCB waiver pa-tients, dual eligibles & eventually all the aged & disabled into managed care; cutting nursing home fees $470 million (but HCB waiver slots will supposedly be opened); hospital rates $478 million, managed care contracts $58 million & psychi-atric care $135 million. He’s giving ADAP only $5 million--but $22 million more is needed for the 413 on the waiting list.

Oklahoma---this 209(b) state’s aged/disabled level is $716 (the SSI/SSP rate). The parent level is 37% & 53% wkg (‘11) & ADAP’s is 200%. It  won’t cover hospices. The state covered the breast & cervical cancer & work-ing disabled groups & subsidized insurance for students, the unemployed & workers under 200% in qualified small firms. The legislature (R) later cut the insurance plan premiums & eligibility but also cut its benefits; cov-ers assisted living, raised the CHIP level from 185 to 300%; favors HSAs in employer plans; and gutted the ins-urance minimum benefits law Gov. Fallin (R) may drop pregnant women’s dentistry, durable medical equip & nebulizors and cut dialysis, diabetic supply, hospital, MD & nursing home fees;  raised some co-pays; seeks to limit ER visits to 3/yr; cut mental health care; closed 200 mental hospital beds; cut covered brand Rx’s from 3 to 2/mo and ended speech, occu & phys therapy benefits. The hospitals got the House to pass a hospital “assess-ment” to attract more US matching & the Senate voted to use $15 million in unspent ARRA funds on Medicaid.  

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), 32%/40% wkg for parents (‘11), 185% for insurance subsidies for non-Medicare adults (with enrollment closed) & 200% for ADAP. An anti-tax referendum cut el-igibility & adult dentistry and ended adult vision care. With a $577 million 2011 deficit, the OR Health Plan expansion waiver--with limited Medicaid for non-Medicare adults under 201%--again froze enrollment. ADAP has cost-sharing. Ex-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 children, raise CHIP’s level to 300%, cover another 35,000 adults & offer more home care---yet he later had to end home care for 100s of cases. Gov Kitzhaber & the Senate (both D) want to expand coverage but have to cut provider fees 16 to 19%, while the new House is tied between Ds & Rs. 

Pennsylvania---has an aged/disabled level of 100%, a parent level of 26%/46% if wkg (‘11) & an ADAP level of 350%. It subsidized “AdultBasic” insurance for 40.000 non-Medicare adults under 208%  (it had no mental health or Rx benefits & 496,000 on its waiting list). Ex- Gov. Rendell (D) covered the wkg disabled, raised the SPAP level (to $23,500 for 1 & $31,500 for 2, covering 90,000 more aged, but still excludes the disabled). Gov Corbett (R) & the new legislature (both Houses are now R) want to drop adult dentistry, cut mental & women’s health services; oppose any expansions; andabolished the Adult Basic program on Feb.28. (But income & medical records reviews suggest that nearly half the drop-ped  patients may well be eligible for Medicaid & they’ve been told so by letter, according to Community Legal Services of Phila.). The 2012 deficit is $4 billion. Phila. city clinics now charge $5-$20 a visit. Rendell priced the premiums as low as $283/mo for those under 200% in PA’s US health reform-funded risk pool, but HHS refused his plea to waive the US risk pools’ 6 months-with-no-coverage rule even for those former AdultBasic patients who’ve been still left uncovered. 

Rhode Island---has these income levels: aged/disabled, 100%, parents, 175% (181% wkg), CHIP, 250% & ADAP 400% (it was cut to 200%, briefly causing a waiting list). The state covers the wkg 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). Ex-Gov Carcieri (R) required free & discount hospital care for those under 200% & 300% and banned taking debtors’ homes. Big deficits ($107 million in 2011) moved him to get a waiver with extra up-front US funds; in exchange it requires shifting 12% of nursing home cases to cheaper home care & caps future US funds. The legislature (D) raised adult daycare co-pays; dropped coverage of legal alien children.& ended childcare workers’ insurance. Gov. Chaffee (I) is expected to have a moderate health policy. 

South Carolina---has no spend down. Its aged/disabled level is 100% & its parent
 levels are 50%/93% if wkg (‘11). It cut its ADAP level to 300%. Its risk pool has a Medicare supplement but no low income premium discount. Ex-Gov Saford & the legislature (both R) limited Rx’s to 4/mo & raised CHIP’s level to 200%. The SPAP has a 200% level but exc;udes the disabled. 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. It also ended SPAP payments for drugs not covered by Pt D, cut SPAP funds & ended state ADAP funding--dropping 200 patients. It may drop 200 more (even with a waiting list already at 693), cut home, personal aide, HCB care (the last 3 face court suits) & covered Rx’s from 8 to 7 mo & de-funded cancer screening.  Gov Haley (R) planned to end hospice coverage (but then relented). She cut speech &occu therapy sessions from 225 to 75/yr. For now, the state won’t impose more cuts in spite of a $200 million deficit thatis soon rising  to $1 billion. Haley plans to save $200 million more with” public-private care provider partnerships”.

South Dakota---has no spend down. Its aged/disabled level is $674/mo (the SSI rate), its parent level is 52%, wkg or not (‘11) & ADAP’s is 300%. Rejecting a call for expansion, the legislature (R) refused to raise the pregnant women & CHIP levels to 250% or increase provider fees & ended adult dental coverage.  Gov. Daugaard (R) said he’d make $30 million in Medicaid cuts (with 10% lower provider fees), but the legislature restored $12.5 million to soften the provider fee cuts

Tennessee—Ex-Gov Bredeson (D) & the legislature (R) set the aged/disabled level at $674/mo (the SSI rate), parents’ at 70%/127% if wkg (‘11) & 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 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 bare-bones insurance for non-Medicare adults under $55,000 (enrollment is closed). CHIP uses Medicaid Rx rules, but also co-vers di-abetic items & more psychiatric Rx’s. Home care & medical equip benefits were cut, with big mental health cuts & a $500 million hosp rate cut —forcing Nashville Gen Hosp to deny non-emergency care to indigent illegals. The state deferred caps on MD visits, transportation & transplant care, kept a $10,000/yearly benefits cap; limited occu, speech & phys therapy; and capped X-ray & lab usage & ADAP costs. A court voided its 1987 order grandfathering-in 150,000 ex-SSI recipients to Medicaid (see “Daniels Case” at www.tnjustice.org). Gov Haslam (R) favors even more cost-cutting by ending coverage of caesarians, hemophilia, detoxification, acne & some sedatives & may even start an ADAP waiting list.

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 (‘11) & the ADAP & CHIP levels are 200%. Gov. Perry & the legislature (both R) dropped  CHIP prostheses, phys  therapy & private duty nursing; raised CHIP cost-sharing; cut Med-icaid home health & ended adult chiropractic & podiatry care; capped the number of Rx’s covered monthly; moved pa-tients into HMOs; but restored Medicaid mental health, vision & hearing aid coverage and CHIP mental health & dentis-ry (Medicaid also covers some adult dentistry); required some mental health parity in private plans & set up a SPAP for HIV clients. A non-profit (www.TexHealthCoalition.org) fosters subsidized health plans for workers under 300% in small firms in Waco, Dallas, El Paso, Ft. Worth, Galveston & Houston. A court order to improve child health & EPSDT requir-es higher MD & DDS fees (but even so, Perry plans a 10% provider rate cut). The 2011-12 deficit is $25 billion. The leg-islature cut the Children with Special Health Needs program--plus a cystic fibrosis aid program for all ages--by $3.5 mil-lion (even with 950 children on a waiting list); refused to fund 13,000 needed HCB waiver slots, plus $19 million that ADAP needs & authorized cutting its level from 200 to 125%  if necessary--even though 15,000 patients already rely on it. A Senate-House budget conference committee left $4.8 billion of the Medicaid budget unfunded (until early 2013,  when funds run out & the state must either raise the money or making huge Medicaid cuts. Ironically, they also authorized transferring $19 million from Medicaid’s already-under-funded budget to ADAP’s even more desperate budget needs). 

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 (‘11) & CHIP’s is 200%. A waiver—now closed to new patients--gives limited O/P care, with big co-pays, to non-Medicare adults (even if childless & non-disabled) under 150%. The legislature (R) ended coverage of  podiatry, audiology, speech therapy, chiropractic, outdoor wheelchairs and adult eyeglasses & dentistry (one patient’s untreated tooth infection spread fatally to her brain); cut hospital & DDS fees 25%; but subsidizes insurance for workers under 150% in small firms. A legislative panel called for gutting the minimum benefits law. a ban on pre-existing condition rules; & urging employers to offer HSAs instead of regular insurance. The state lets insurers sell even-cheaper-than-COBRA, barebones policies. Gov. Herbert (R) restored dental care for children & pregnant women and some phys & occu therapy. Yet they cut DDS fees again (which CMS then disapproved); and cut its ADAP formulary & income level (to 250%, dropping  89 clients) closed enrollment to new patients & again has an ADAP  waiting list (of 6 so far); cut the disabled level from 100 to 74%, school health funds & the pregnant women’s asset level & even dropped the spend down. Herbert will sign a bill to force Medicaid patients to “work” for their benefits.

Vermont—Its levels are: aged/disabled (2 zones) 101% & 110%; parents, 185%/191% if wkg (’11); childless, non-disabled adults, 150% /160% if wkg; CHIP, 300%; ADAP, 200% & the SPAP, 175%. There are no MSP asset tests. The state subsidizes 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. Ex-Gov Douglas (R) promis-ed not to cut eligibility (even signing  a bill requiring more private plan autism coverage), yet raised SPAP co-pays & re-quested more client cost-sharing (but the Democratic legislature blocked CHIP premiums), capped allowed ER visits; and cut provider & Rx fees. Gov Shumlin (D) signed a bill to establish a state single-payer health insurance system.

Virginia---this 209(b) state’s parent level is 25/31% if wkg (‘11), CHIP’s is 200% & ADAP’s is 400%. It covers the wkg disabled & has a SPAP for HIV+ Pt. D patients under 300%. Gov. McDonnell & the House (both R) ignored gentler Senate (D) proposals to cut provider fees & mental health, substance abuse & community care funds, lower the $2,200/mo HCB waiver income level to $1,685, even with a waiting list of 6,000 (but $30 million was later found for HCB care); cut CHIP’s level from 200 to 175% (which will turn away 28,000) & the aged/disabled level from 80 to 75%. ADAP’s  formulary was cut, it closed enrollment & dropped 760 patients (except pregnant women, children & those with CD4 counts under 350 or who’ve had opportunistic infections). The waiting list was already 57 & even after the state added $6.2 million more for biennium, it still rose to 684 (and may rise by 760 more). A bill passed to make big firms’ health plans cover some autism care–-and McDonnell’s line-item veto to reduce coverage & employer costs was overridden.   

Washington--its risk pool has a supplement open to some, but not all, Medicare patients. Its aged/disabled level is $720 (the SSI/ SSP rate), its parent level is 37%/74% if wkg (‘11) but ADAP’s 300% level was cut to 275%. Gov. Gregoire & the legislature (both D) passed mental health parity. Budget cuts forced her to end CHIP for 27,000 undocumented chil-dren. The state raised BasicHealth (its subsidized insurance for non-Medicare adults under 200%, with a waiting list of 150,000) premiums & co-pays, forcing 60,000 off the rolls; ended medical assistance for 21,000 disabled clients; cut DSH payments & nursing home fees; and limited Rx, DME, imaging, denture, diabetic supplies, personal aide, home care, adult day care, maternity & infant casework & incontinence benefits and cut druggist, pediatric MD, HMO & day health center fees. It dropped adult hearing aids, podiatry, eyeglasses, dentistry, & colorectal cancer screening. ADAP’s formulary was cut &cost-sharing was required, it may have to drop 500 clients & 25% was cut in other HIV care. The state offers slightly discounted, unsubsidized insurance. A Medicaid waiver gives matching for BasicHealth & its Disability Lifeline  medical assistance,  but it had to cut 17,000 off BasicHealth for being illegals, over 65, or having income over 133%; and the leg-islature cut Medicaid’s provider payment budget by $4 billion, over bitter opposition by hospitals & home care workers. 

West Virginia---has an aged/disabled level of $674/mo (the SSI rate), a parent level of 17%/33% if wkg (‘11) & a 250% ADAP level. It covers only 4 brand Rx’s/mo (plus 6 generics). Its risk pool has no Medicare supplement but low income premium discounts have been authorized. It denies all adult dental care but extractions & emergencies & didn’t properly adopt 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 planned to put the disabled, parents & children into managed care that some say cuts care access. Gov Tomblin (D) & the legislature passed a hospital tax with proceeds to be used to attract more US Medicaid matching.    

Wisconsin---has an aged/disabled level of $757.78/mo (the SSI/SSP rate),a 300% ADAP level & a 240% SPAP level  (which excludes the disabled). The risk pool has a Medicare supplement & premium discounts for those under $33,000 Ex-Gov Doyle & the old legislature (both D) raised the CHIP (185 to 300%) & parent (185 to 200%) levels & started a “Basic Care” plan for non-Medicare childless adults under 200%. But its caseload soon exceeded funding capacity (with 100,000 more on a waiting list). In 2012, the state needs $675 million more for health assistance (and has a $2.7 billion deficit)  but Gov Walker & the new legislatue (both R) plan $3 billion in Medicaid cuts, including dropping 44,000 child- less, non-disabled adults. He signed a GOP-passed bill to give him sole power (reviewable only by a rubber-stamp GOP-packed legislative panel) to change Medicaid & other health programs’ eligibility, cost-sharing, benefits & payment laws & policies in order to cut $500+ million yearly—and then began removing those 44.000 adults from Basic Care. On the other hand, even GOP legislators rejected his attempt to cut SPAP coverage (called “Senior Care” in WI).   

Wyoming--has no spend down, an aged/disabled level of $699 (the SSI/SSP rate), a parent level of 39%/52% if  wkg (‘11) & a 200% CHIP level. Its SPAP covers non-Medicare persons below 100%. The legislature (R) widened CHIP mental health, vision & dental benefits. Ex-Gov Freudenthal (D) added a risk pool low income premium discount for those under 250% (it already had a Medicare supplement) & finalized plans with GOP legislators to offer cheap, subsid-ized (but very limited) preventive-oriented insurance for working adults under 200% during  2011. Next year’s Medicaid budget shortfall is $192 million. The state plans to cut provider fees $25 million, the DD & HCB budget $3.6 million (freezing-in a waiting list) & state dialysis aid $250,000. ADAP’s 332% level was cut, its formulary & enrollment were capped (the waiting list is 4 so far) & client cost-sharing was imposed.  Gov. Mead (R) plans even more healthcuts.

SOURCES AND RESOURCES:

Email sherry.barber@ssa.gov for “State Asst. Programs For SSI Recips., 1/10” (the latest update) on state Medicaid eli-gibility rules for SSI & SSP recipients, state SSP amounts and state Sec. 1616, 1634 & 209(b) eligibility arrangements.  

For the 48 states & DC, 2011’s federal poverty level (FPL) is $10,890 yearly ($907.50 monthly) for one plus $3820 yearly  ($318.33 monthly) for each additional person; see the Assistant Secretary for Planning  & Evaluation  pages at www.dhhs.gov for earlier years’ FPLs and Alaska’s & Hawaii’s separate FPLs. The basic 2011 SSI rates (not includ-ing any state supplements, or SSPs) are the same as in 2009 & 2010:  $674 monthly  for 1 & $1,011 monthly  for 2.  

For state parent & childless non-disabled adult income levels see “Holding Steady: Looking Ahead.. 50-State Survey of Elig. Rules..[for Parents & Childless Non-Dis Adults]2010-11” [pub.#8132, Tbls B, 4 & 5],“Medicaid..[& MSP] ..Elig..[Levels]  ..for..Elder[s]&..Disab[led] 2009-10 ..”[pub #8048, Tbls 1 & 6] in the Medicaid pages at www.kff.org. and http://www.kff.org/medicaid/upload/8105.pdf  for more detailed 2010-11 aged/disabled eligibility data (App. A4a). 

“Medicaid Expansion Now..[Can]..Save..States Money” at www.kff.org shows how states can add to their health budgets by now getting regular Medicaid  matching rates for 100% state-funded care of childless, non-disabled adults under 133% & “Explaining: Benefits & Cost-Sharing..States Can Set For [New]..[Eligibles]..” (8/9/10) For CMS rules on covering new clients see State Med Dir Ltr #10-005, “New Options.. Under Med..” (4//10/10) & State Med Dir Ltr #10-013 (7/2/10) on required “Fam, Plan. , Benchmark, [mental health & Rx] Coverage” at www.cms.gov 

“Medicaid Coverage & ..[Costs]..in Health Reform..” at www.kff.org projects the numbers of new Medicaid patients & the states’ tiny share of their costs starting in 2013-14 (0% to 10%). See “ The ..States’.. Next Challenge: ..[Getting]..Primary Care to..[more..Medicaid...Patients..]” in the “New England Journal of Medicine” (2/10/11). 

“Net Effects of the Affordable Care Act on State Budgets”at www.firstfocus.net sees state savings of $40.6 to $131.7 billion from health reform yearly in 2014-19. The Act & HHS regulations issued on April 15 and/or 19, 2011 gives them a 90% federal match to set up & improve Medicaid & Exchange enrollment systems & a permanent 75% US match to run them (the old Medicaid administrative match—including that for eligibility & all other administrative & claims-payment work—was only 50%)  

See “Rep.Rpt. Inflates State...Costs [In] Health Reform”at www.cbpp.org, “Medicaid & the ACA: Reframing…”at www.familiesusa.org, http://www.kff.org/healthreform/8149.cfm & http://ccf.georgetown.edu/index/medicaid-and-state-budgets on state costs & savings & “Medicaid’s Role in..Health..Exchanges: A Road Map..” at www.manatthealthsolutions.com   

The ACA “Maximiz[es].. [Primary MD].. Medicaid Rates to Medicare Levels [to get more primary care MDs to take Medicaid patients]..” at www.chcs.org by paying 100% of states’ added fee costs in 2013 & 2014; and new HHS rules make future state provider pay cuts much harder, cumbersome & time- consuming (Fed. Reg., 5/ 5/11); see “NHeLP Breaks Down Crucial Prov Pay Reg”at www.healthlaw.org 

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, occu & speech therapy coverage. 

The “2011 National ADAP Monitoring Report (Module 1)” at www.nastad.org lists state income (and, if applicable, asset) eligibility levels in Table 13, their application procedures in Table 14 & any prior authorization rules they have for special or costly drugs in Table 15.  Its “(Module 2)” contains a “Glossary” and charts & tables on state ADAPs’ coverage of Hepatitis B & C drugs & care (which are often co-morbid with HIV). States’ ADAP formularies weren’t compiled in this year’s ”Report” (so, while it does list some state prior authorization rules for costly or unusual drugs, it merely offers state ADAP contacts to request their formularies). See the “ADAP Watch” at www.nastad.org for the latest on state waiting lists; and current &back issues of the “ADAP Pill Box” at www.ADAPAdvocacyAssociation.org    

 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 a chart on how Rx maker PAPs mesh with Pt D. States can cover Pt-D-excluded Rx’s with their own funds: see which do so at www.medicareadvocacy.org (12/1/05 report at “News” icon). National Public Radio reported on 4/20/11 that 75% of  prescriptions now written in the United States  are already for generics. 

“The State of Children’s Dental Health: Making Coverage Matter” at www.pewtrusts.org finds that only 7 states have good dental access & care for children (especially those on Medicaid or CHIP). Maryland has the best record.  

“Medicaid Managed Care Trends” (2009) on Medicaid’s research &demonstration pages at www.cms.gov shows that over 70% of Medicaid patients are already enrolled—often mandatorily- in private contractor managed care plans (so far they’re mostly non-disabled parents & children, except in some rural areas); but, with budget crises, most states now plan to enroll (often mandatorily) the previously mostly-exempt aged & disabled too (sometimes even SNF, ICF and  board & care home care clients, plus DD patients in day, sheltered work & residence programs). But see “CA’s Shift to Managed Care Doesn’t Save Money or Improve Outcomes” (10/05) reporting that it actually raises costs 17% higher than fee-for-service coverage (10/05) at http://www.rwjf.org under “publications & research”; and a sum-mary of conflicting studies on cost savings or increases in “Managed Care Explained..” (5/31/11) at www.stateline.org    

“Insurer-owned [i.e., private managed care plans’] Clinics Seek to Improve Health Care, Curb Costs” (5/4/11) in www.philly.com reports that some privatized Medicare Advantage & Medicaid managed care plans (Bravo, Humana, etc) in Philadelphia & Baltimore run comprehensive, fully-equipped, well-staffed walk-in urgent care clinics open much longer hours—cutting Medicare and Medicaid ER and hospital costs. Also see “Hospital Emergency Depart-ments: Health Center Strategies That May.. Reduce Their.. Use” (GAO Rpt. 414R; 4/11/11) at www.GAO.gov     

“Implementing National Health Reform:  A Five-Part Strategy For Reaching the Eligible Uninsured” (5/11), under “publications” at www.ui.urban.org offers well-thought-out methods for quick, simple & efficient mass-enrollment by states of millions of uninsured in 2013-14.  

For a good complementary look at one aspect of this massive challenge, see also “Financial Counsel-or Qualities” in the “Management Corner” column of CCH’s “Receivables Report” (4/11; Vol. 26, No. 2; paid sub-scription required). It addresses the skills & qualities needed by such [typically hospital-based] professionals who help the un- and under-insured who are emergency-admitted to get Medicaid or other medical coverage. They’ll face much-increased responsibilities & caseloads with the millions of uninsured persons who’ll be emergency-admitted to hospi-tals starting in 2014---who’ll have to be screened, processed  and helped in applying for Medicaid or subsidized Ex-change health insurance. [Financial counselors are little-known specialists,--often erroneously seen as mere “clericals”; but they’ve long been a first line of access to medical coverage for the uninsured, especially emergency-admitted hospital patients. Their caseloads & responsibilities will swell as Medicaid is expanded & Exchange health insurance becomes available to mil-lions of un-covered persons.  Learning of the eclectic, varied backgrounds (with no official professional certification, or edu-cational or experience standards other than a working knowledge of medical assistance eligibility & procedures), skills and du-ties of these often-disdained professionals---and increasing their numbers—is crucial to fully  implement health reform.]     

See “Indiv..Models of LTC’ at www.statehealthfacts.org for state coverage of  HCB waivers, home health, personal aides for the disabled.  Get a 2009 list of state Personal Needs Allowances (PNAs) for SNF & ICF patients and residents of state-licensed SSI SSP-funded board & care homes from lsmetanka@nccnhr.org. Also see “Medicaid HCB Services Data Update: 2011” & a “Mo-ney Follows the Person Snapshot, 2010” at www.kff.org. With no implementing regulations or administrative directives yet issued, CMS & patient advocates will discuss the health reform law’s “Community First Choice” state plan option  to give states 6% higher  matching for personal attendant services costs to avert institutionalization & a “Balance Incentives Payment Program” offering them as-yet-unspecified grants to plan & arrange such services in a 6/3/11  conference call at 2PM Eastern Time; see www.ncoa.org ).   

See www.naschip.org on the pre-health reform state risk pools & order “Compr. Health Ins. for High Risk Indivs: .. State-by-State…” on funding, eligibility, benefits, Medicare supplements, premiums & low income discounts. The site  www.pcip.gov shows if new US health reform-funded  pools are state- or US-run and their premium & cost-sharing amounts (many are surprisingly affordable, especially for those under age 40; and premiums in US-run pools have just been reduced). 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 the “Other Organizations’ Materials” section under ”Medicaid” below “Issues” at www.healthlaw.org for a Medicaid (and related health & welfare) “Glossary”, “2011 VA Health ..Benefits”, ”Painless Ways To Deal With State Medicaid Shortfalls” and “Ways To Stretch ADAP Budgets”.