State Medicaid cuts hit home

Medicaid will be cut for more than 2,000 people in Boone County.
Sunday, June 12, 2005 | 12:00 a.m. CDT; updated 7:57 a.m. CDT, Friday, July 18, 2008

The impact of state Medicaid cuts on Boone County is just beginning.

“We’re already getting calls about people anticipating losing their coverage,” said Steve Hollis, a social services supervisor at the Columbia/Boone County Health Department.

In Boone County, 2,058 individuals will lose coverage in the next year under the state health-care program, according to figures provided by the state Department of Social Services. About 100,000 out of 1 million Medicaid recipients will lose coverage statewide.

The cuts will take effect in July and August.

As the number of low-income people who will lose coverage comes into focus, health officials are starting to gauge the effect on local services.

The Family Health Center is the only federally-funded health-care center for low-income patients in central Missouri. Executive Director Gloria Crull said the cuts will affect the total operation of the center, which serves people receiving Medicaid and other patients — whether insured or not.

“We cannot estimate the impact,” she said. “That’s the bottom line. We may seek other grants and, of course, we’ll use the federal grants as far as they go. The problem is that it’s a limited resource.”

Crull said patients are wary of the cuts. “We’ve had a number of established patients express concerns during their medical visit,” she said.

Services provided by the city-county health department include reproductive health services, testing and treatment for sexually transmitted diseases and social services, but not routine health care.

The cuts will make the department’s social service jobs more difficult, Hollis said. Those services are assisting with medication, helping people find care and identifying eligibility for Medicaid programs.

The cuts will limit the department’s ability to identify health-care options, Hollis said, especially since the General Relief program is being eliminated along with major cuts to Medical Assistance for Families.

“The recourse will be that we’ll either convince the Family Health Center to see (patients) or they’ll use the ER,” he said.

Crull also anticipates that the cost is ultimately borne by the community.

“The wisest choice is to cover primary health care because the costs are minimal, instead of letting illness exacerbate and treating an acute illness at a much higher cost,” Crull said. “If you look at Medicaid from the perspective of benefits to the community, then you have adults who are gainfully employed and children who are participating in school.”

Lynn Hostetler, director of communications at Boone Hospital Center, said the cuts, in the long run, “could increase the amount of unreimbursed care that we provide.”

Jennifer Roberts of the Department of Social Services in Boone County noted that some people losing coverage in nearby counties will seek care in Columbia.

“Not every county has a major hospital, so some come to Boone County,” Roberts said.

The Missouri Department of Social Services has sent nearly 70,000 letters statewide informing recipients of coverage changes. In Boone County, Roberts said letters have been sent telling 426 people they will be cut from Medicaid along with an additional 910 letters telling people they may receive transitional Medicaid for one year.

One reason so many people are losing coverage under the Medical Assistance for Families program is because their income is too high, Roberts said, noting that the guidelines for determining what constitutes “poverty” and eligibility for Medicaid have been drastically changed.

For example, a mother with one child previously could earn $802 per month and qualify for the program. Under the new guidelines, she would have to earn less than $234 a month.

“The guidelines are extremely low to begin with,” Hollis said. “Now, they’re ridiculously low.”

Deborah Scott, spokeswoman for the Missouri Department of Social Services, said the cuts were necessary as the cost of Medicaid escalated. “The state could no longer afford to offer the coverage that we were offering,” she said. “Some tough decisions had to be made.”

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