Psychiatric News February 4, 2005
Volume 40 Number 3
© 2005 American Psychiatric Association
p. 6
Benefit Cuts Force Many To Make Painful Choices
Kate Mulligan
Oregonians talk about the heart-wrenching consequences of cuts in their
health care benefits.
A former beneficiary of Oregon's Medically Needy program described her
current dilemma, "My total income is $740 a month. My total medical bill
is $912 a month. You do the math."
That stark assessment took place in one of a series of focus groups
convened by the Kaiser Commission on Medicaid and the Uninsured (KCMU) to
consider the impact of Medicaid cost-saving measures in Oregon.
The groups met in Portland in February 2004, a year after the state had cut
benefits to its Oregon Health Plan (OHP) Standard population and increased
their premiums and cost-sharing requirements (Psychiatric News, April
4, 2003; July 16, 2004).
OHP Standard beneficiaries include parents and adults who are not eligible
for Temporary Assistance for Needy Families or general assistance. They are
poor, however; their income cannot exceed the federal poverty level. The group
generally is known as the Medicaid-optional population.
The state also eliminated its Medically Needy program, an optional Medicaid
service that provides benefits to individuals whose high medical expenses
reduce their available monthly income to a level specified by each state.
Oregon had set the monthly income limit at $413 or less and provided benefits
to nearly 9,000 people.
"The Impact of Medicaid Reductions in Oregon: Focus Group
Insights" was released in December
2004.
Prescription Drugs vs. Meals
Seven individuals, all of whom have chronic and debilitating illnesses,
made up the focus group of those who had lost coverage through the Medically
Needy program.
They reported that loss of prescription drug coverage had led to
significant problems because prescription drugs currently are not covered by
Medicare, and they are taking multiple medications.
Their comments echoed the findings of a survey conducted by Judy Zerzan,
M.D., of the Oregon Health Research and Evaluation Collaborative. She surveyed
a sample of the population six months after the program ended.
Respondents reported needing an average of 5.5 prescriptions each month.
Twenty-six percent reported a prescription for an antipsychotic
medication.
Sixty percent reported that they had cut back on their food budget to pay
for medications, and nearly half reported that they had skipped paying bills,
paid bills late, or borrowed money from family or friends to pay for
medications (see pie charts on facing page).
Enrollment Halved
Enrollment in the OHP Standard program declined from approximately 102,000
in January 2003 to 46,520 in October 2004, according to data supplied by state
officials to the KCMU.
Ten individuals constituted the focus group of those who had become
"disenrolled" from the OHP Standard program.
Respondents reported difficulties paying the increased premiums of $6 to
$20 a month. One former enrollee said, "I mailed my payment in, and I
was late and kicked off. My doctor and the hospital wrote letters trying to
get them to budge, and they wouldn't budge and so I lost."
At the time of the focus group, an individual was disenrolled after being
late with one payment, but could attempt to reenroll after six months.
Enrollment was closed as of July 2004, however, eliminating any possibility of
reenrollment.
Those who lost coverage reported that they relied on clinics, emergency
rooms, prescription drug donation programs, and drug samples for their health
care needs.
One woman said, "I was on seven prescriptions when I came off the
plan. My pharmacist at my clinic has been working with me and kept me on three
of them."
Members of the group believe that their health has deteriorated and are
fearful of becoming seriously ill.
Enrollees in OHP Standard initially lost coverage for mental health
services, durable medical equipment, and dental and vision services. Coverage
for mental health services has since been restored.
Twenty OHP Standard enrollees participated in two focus groups of 10
members each.
At the time of the focus group, mental health benefits had not been
restored. Problems stemming from the loss of that coverage were particularly
pronounced, according to the report.
Members of the focus group said that although they were able to get
antipsychotic medications, they could not receive counseling. One member of
the group spoke about the difficulty of getting those medications from her
primary care doctor.
Another group member told of having a tooth pulled, leaving a "big
hole" in her mouth, because it was the only free treatment available.
"I'm only in my 40s, and they said every time I get a toothache, they'll
just take another tooth until OHP covers it again."
At press time, Tennessee Gov. Phil Bredesen (D) announced that he was
eliminating health care coverage for approximately 323,000 of the state's
residents enrolled in TennCare, the state's program for Medicaid beneficiaries
and other needy residents.
Like Oregon, Tennessee built on its Medicaid program to provide benefits to
poor, disabled, and uninsurable people who do not meet all of Medicaid's
eligibility criteria.
The state will impose limits on the number of prescription drugs and
physician visits for the remaining 396,000 adults enrolled in the program.
The 612,000 children enrolled in the program will not be affected by these
cuts.
Analysis of the potential impact of the cuts will appear in a future issue
of Psychiatric News.
"The Impact of Medicaid Reductions in Oregon: Focus Group
Insights" is posted online at
<www.kff.org/medicaid/7233.cfm>.
Related Article:
-
Mary's Story
Psychiatr News 2005 40: 7.
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