By Carrie Brown McWhorter
Health care continues to be a hot-button issue in Alabama, and perhaps no single topic gets more attention than Medicaid.
Medicaid and the Children’s Health Insurance Program (CHIP) provide free or low-cost health coverage to more than a million people each year in Alabama, a quarter of the state’s population. More than half of all children in Alabama are eligible for Medicaid.
Medicaid eligibility is based on several factors, but the program serves low-income people, families and children, pregnant women, the elderly and people with disabilities. Both Medicaid and CHIP are run jointly by federal and state governments, a fact that continues to cause friction in cash-strapped Alabama. According to the Public Affairs Research Council of Alabama, total spending on Medicaid in Alabama is expected to reach $6.1 billion in 2015, with about 30 percent of funding coming from state sources and 70 percent from the federal government.
Derailing efforts
The budget passed by the Alabama Legislature during the regular session called for a 5 percent cut in funding to Alabama’s Medicaid program. According to a statement on the Alabama Medicaid Agency’s website, that reduction in funding would “derail the agency’s planned transformation efforts” and “potentially lead to deep cuts and a program that is simply not viable.” Gov. Robert Bentley vetoed that budget, calling it “unworkable.”
During the first special legislative session, Rep. Steve Clouse, R-Ozark, proposed a $156 million cut in funding for the state Medicaid program after the budget committee rejected a cigarette tax that would have allowed for level funding of Medicaid. None of the governor’s other revenue proposals were included in the House budget, and the session ended without passage of a General Fund budget.
In a series of tweets Aug. 19, Bentley expressed his concerns about cuts to Medicaid. He said he would not support a budget that cuts Medicaid and that cuts would negatively affect rural communities and nursing homes in Alabama.
“What would you do if a loved one had to be removed from a nursing home (because) of cuts? It’s possible,” the governor tweeted. “Medicaid is an important component of health. Our rural hospitals, physicians (and) nursing homes depend on Medicaid. Our citizens deserve better than to have their rural hospital(s) close.”
Officials with the Alabama Medicaid Transition Task Force have implemented several reforms in the past three years to make Medicaid run more efficiently both financially and operationally. In May, Dr. Don Williamson, director of the Alabama Department of Public Health and chair of the task force, said without adequate state funding the efforts made to improve Medicaid in the state could not be maintained.
Williamson said cuts would force the elimination of optional programs such as adult eyeglasses, outpatient dialysis, hospice and orthotics. The state also would have to reduce payments to providers and move to a more restrictive pharmacy benefits program, he said.
“Clearly these types of cuts would jeopardize the viability of the Alabama Medicaid program,” Williamson said. “At a minimum, they would dramatically limit access for recipients, especially in rural areas and would likely result in physicians leaving the state.”
In the agency’s annual report for fiscal year 2012, acting commissioner Stephanie Azar cited a 2012 economic impact study that “found that every dollar the state invested in Medicaid in 2010 generated a return of $8 to the state. Overall nearly $9 billion in monetary impact was attributed to Medicaid.” The study referenced was conducted by Auburn Montgomery Center for Government. The study also noted that Alabama Medicaid was responsible for approximately 147,000 jobs created or supported and for $592 million in taxes generated in 2010.
Significant impact
Beyond jobs, however, the impact of Medicaid on Alabama’s youngest citizens is significant, said Michael J. Ramsey, a pediatrician in Dothan and president of the Alabama Chapter-American Academy of Pediatrics.
In a letter to the editor of the Dothan Eagle in May, Ramsey called Medicaid “one of the pillars of pediatric health care.”
“The average pediatric practice in Alabama has 30 percent of its patients covered by Medicaid. Pediatric subspecialists are disproportionately paid with Medicaid dollars. Without a healthy, vibrant Medicaid system, there is no way to provide a sustainable infrastructure for pediatric care for any child, regardless of insurance,” he said.
“With its proposed budget cuts for nearly every government agency, the Alabama Legislature is playing a very dangerous game with the health and well-being of the children of Alabama.”
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