Hard times taking some of the aid out of Medicaid

NORFOLK

James Parker cringes when he thinks about cuts to Medi­caid insurance that could make it even harder to get the medical care he needs.

The 54-year-old Norfolk resident has multiple sclerosis and receives primary care at a community health clinic. When he needs a specialist, however, it’s a fight to find a doctor who will see him.  

He’s one of more than 775,000 Virginians covered by Medicaid, a shared state and federal insurance program for the disabled and people with low incomes.

The ailing economy is putting the program under unprecedented pressure for two reasons: More people are qualifying for the insurance because they’re losing jobs or earning less; and state legislators facing budget shortfalls  are looking for ways to cut Medicaid expenses by curtailing services or reducing reimbursements to health-care providers.

The Medicaid program already pays doctors and hospitals much less than private insurance does – below actual costs in most cases. Many doctors, therefore, do not accept Medicaid patients or restrict their practices to a certain number.

In Virginia, both the House and Senate budget proposals included cuts in reimbursements to hospitals and doctors, though they differ in how much. Legislators, who will take up the issue of the budget again today , hope  federal funding will come through to help make up for some of the proposed Medicaid reductions.

Cuts also are being considered for FAMIS, the state’s health insurance program for low-income children and pregnant women.    Reductions in health care for low-income populations are likely to have ripple effects.

Parker’s physician, Dr. Subir Vij, would deal with them firsthand. “We’re already seeing more people with Medicaid and more people who are uninsured,” said Vij, an internal medicine doctor who practices at Park Place Medical Center in Norfolk. “They had a nice job with insurance, but then they lost their job, and their doctors kicked them out.”

About 25 percent of patients who visit the community health center are on Medicaid, a higher rate than at a typical family practice. An  additional 40 percent are uninsured. Community clinics are federally funded and do not turn away Medicaid patients.

Still, growth and possible reimbursement cuts could translate into longer waits.

Two years ago, for instance, it took about two weeks for a new patient to get an appointment. Now it can take six weeks. In 2009, the number of patient visits at Park Place and its partner center, Portsmouth Community Health Clinic, was 38 percent higher than the previous year.

Many Medicaid patients arrive after being turned down by other doctors.

The same trend is unfolding across the nation as the number of people on Medicaid grows.

A survey released last month by the Kaiser Family Foundation found a record one-year increase – 3.3 million patients – in Medicaid enrollment from June 2008 to June 2009. Virginia’s growth was 8.2 percent, higher than the national average of 7.5 percent. Nearby Maryland saw a 20 percent jump, the highest in the nation.

Because Medicaid enrollment often lags behind a rise in unemployment, an even bigger increase could occur this year, according to the analysis.

Virginia legislators had proposed Medicaid reimbursement cuts to hospitals last year, but federal stimulus money helped fill the gap. Portsmouth Community Health Clinic also received about $219,000 in stimulus money last year, which allowed for the hiring of another doctor and support staff.  

That stimulus assistance is due to expire at the end of December. Although  Congress and the White House are considering extending the payments for six more months, they haven’t done so yet, leaving legislators across the country struggling to make their budget numbers work.

In the Kaiser survey, every state’s Medicaid enrollment rose, and in 32 states, including Virginia, enrollment grew twice as fast as the year before.

Virginia already ranks 48th in the country in Medicaid expenditures per capita, according to a 2008 Joint Legislative Audit and Review Commission fact sheet. And every dollar cut from state Medicaid results in a loss of at least that much in federal matching money.

Barbara Willis, chief executive officer of the community health clinics in Portsmouth and Norfolk, worries that doctors will be even more hesitant to take on Medicaid patients if reimbursements decline any further. Then more people would turn to community health centers, increasing wait times, or go   without care until they were so sick they needed to go to emergency rooms.

Parker, like many patients, can find primary care at community health clinics, but he sometimes has a harder time with specialty care. He needs to see a urologist, but the practice he was referred to several months ago was not taking any more Medicaid patients. “I’m still looking for someone,” he said.

Willis said some practices cap how many Medicaid patients they’ll take, and patients who call after the limit has been reached are turned away.

Some doctors cannot, or will not, turn away Medicaid patients.

For instance, pediatric specialists who work for Children’s Specialty Group base their practices at Children’s Hospital of The King’s Daughters, where about half the patient visits are paid for by Medicaid. Children are more likely to be eligible for Medicaid than adults, so that’s where most of the growth in enrollment is occurring.

  Frank Singleton, CEO of the specialty group, said the doctors  will not turn away Medicaid patients, which means a reimbursement cut would  hit them harder than pediatricians or family practice doctors who choose to restrict their practices.

Emergency room physicians also would bear the brunt of lower reimbursements.

Gwen Harry, executive director of the Virginia College of Emergency Physicians, said that specialty  is legally bound to care for whoever comes into the emergency room. Further, more people unable to find a doctor who will take Medicaid might wait until they are sick enough to end up in the ER.

“That ends up impacting not just the Medicaid patients,” Harry said, “but everyone else who needs care there.”

Elizabeth Simpson, (757) 446-2635, elizabeth.simpson@pilotonline.com