Psychiatr News November 4, 2005
Volume 40, Number 21, page 9
© 2005 American Psychiatric Association
State's Medicaid Deal Could Put Psychiatric Services at Risk
Rich Daly
Vermont strikes a deal with the federal government to gain more control
over its Medicaid program in exchange for a cap on federal contributions.
Three other states also take action on public services.
An ever-increasing Medicaid burden coupled with a decreasing ability to
meet that demand has led Vermont to conclude a first-of-its-kind deal to
revamp the funding relationship between the state and the federal
government.
Gov. James Douglas (R) led the development of the Global Commitment to
Health program, under which Vermont accepted a five-year cap on federal
Medicaid funding and gained unprecedented flexibility to manage the program
and control its escalating costs. The cap approach presets spending on a state
Medicaid plan for the first time and allows the state to retain the funds it
does not spend, according to Judith Solomon, a senior fellow at the Center on
Budget and Policy Priorities. The center is a nonprofit organization that
analyzes federal budget priorities, with emphasis on their impact on
low-income Americans.
The deal specifies that the state may make eligibility requirements more
stringent or reduce benefits; the only exclusion affects beneficiaries for
whom the federal government mandates coverage, such as children from
low-income families.
The new program went into effect in early October, at the start of the
federal fiscal year. Initially, no changes were made to eligibility criteria
or benefits. The earliest that changes can be considered is January 2006, when
the governor begins work on a new budget; any proposed changes would have to
be approved by the legislature, which is controlled by Democrats.
"We are clearly concerned about the implications of Vermont's new
Medicaid plan," said David Fassler, M.D., the legislative representative
of the Vermont Psychiatric Association (VPA) and an APA trustee-at-large.
"While we appreciate the very real financial pressures and
considerations, we worry about losing the safety net for children and adults
with psychiatric illnesses.
"Although the proposal has received preliminary legislative approval,
many of the actual details of critical importance to physicians and patients
have yet to be developed or publicly discussed. The VPA will monitor the
process closely and work with the state medical society and the mental health
advocacy community to ensure ongoing access to appropriate psychiatric
treatment."
The new program will cap federal and state Medicaid spending in Vermont at
$4.7 billion over the next five years, of which the federal government will
pay 60 percent.
Douglas estimated that the five-year spending will be near $4.2 billion,
but Vermont will have to pay the difference if it exceeds $4.7 billion.
Previous estimates projected that an unchanged Medicaid program would cost the
state and federal government $6 billion over the next five years.
The state estimates that it will save between $135 million and $165 million
over the five years, but that is not enough to make up for Vermont's projected
shortfall in covering its Medicaid costs, estimated to remain at $300 million
within that time.
Vermont's program currently covers about 25 percent of all state
residents.
States across the country, along with the Bush administration and the
president's Medicaid Commission, are expected to monitor closely the results
of the Vermont program to see whether it can serve as a model for programs in
other states. Other states considering a major overhaul of their Medicaid
programs include Montana, California, Missouri, and Ohio.
Vermont was one of the first states to expand access to Medicaid beyond the
poor to include middle-class families that met certain criteria. Part of the
intent behind the expansion was to give more children access to health
care.
Illinois Proposes Subsidy for Children
In Illinois, Gov. Rod Blagojevich (D) proposed a plan to provide subsidized
health insurance for 253,000 uninsured children in the state, including many
in families with incomes too high to qualify for government assistance but too
low to afford private health coverage. The Illinois legislature is expected to
consider the governor's proposal during its fall veto session.
The All Kids plan would have parents pay monthly income-based premiums that
in most cases would cost less than private insurance. Copayments would apply
for doctor visits, hospital stays, and prescription drugs. No copayments would
be charged for preventive care, such as immunizations and regular checkups.
The plan would have no deductible. For a family of four with an income between
$40,000 and $59,999, expenses would be capped at $500 annually. That same
family would pay a $40 monthly premium per child, capped at $80. Doctor visits
would cost $10; emergency room visits, $30; prescription drugs, 5 percent of
retail cost; inpatient hospital stays, $100; and outpatient hospital services,
5 percent of cost. Eligibility would be limited to children who have been
uninsured for six months prior to the initial enrollment period.
State officials say All Kids will extend health benefits to 125,000
children who are ineligible for KidCare, the state's SCHIP program. An
additional 125,000 children are eligible for KidCare but are not registered in
the program, and officials hope the publicity about the All Kids benefit will
help them identify eligible families.
Tennessee Helps Underserved Areas
Tennessee awarded $5.7 million in grants to 60 health centers in medically
underserved areas, Gov. Phil Bredesen (D) announced last month. The centers
are part of a $104 million network of programs to provide services to
uninsured state residents and ease the transition for about 190,000 people who
will lose coverage under an ongoing reduction in the size of TennCare, the
state's Medicaid program. The centers are required to provide care on a
sliding-fee scale for adults aged 19 and older.
New Jersey Reaches Out to Latinos
Latinos seeking mental health care in New Jersey face a range of obstacles,
according to the report of the Hispanic Directors Association of New Jersey.
The report, prepared by a panel of 15 New Jersey mental health experts and
released last month, said that stigma, language barriers, cultural
insensitivity, and other issues make it difficult for Latinos to obtain
care.
Among the panel's recommendations to improve the mental health system are
creation of a task force to report on whether changes to the system would help
it to better serve Latinos and foster the appointment of qualified Latinos at
all levels of New Jersey's mental health system. The panel also requested
increased funding for educating Latinos on mental health issues and for the
delivery of outpatient services in Spanish.
Panel members urged that New Jersey mental health screening centers have at
least one bilingual mental health screener on call, increase the detail of
data collected on services targeted at racial and ethnic minorities, and
support mental health training programs on cultural diversity for
law-enforcement officials and judges. 
Get information about faster international access.
Privacy Policy
Copyright © 2005
American Psychiatric Association.
All rights reserved.
Home
| Search
| Current Issue
| Past Issues
| Subscribe
| All APPI Journals
| Help
| Contact Us
| 
