Medicaid budget knife cuts circumcisions

From: Billings Gazette, MT - 21 Dec 2002

By JENNIFER McKEE
Gazette State Bureau
HELENA - People with Medicaid, a federal-state insurance plan for the poor and elderly, will no longer be able to get prosthetic limbs, dental care, circumcisions and some other services, state officials announced Friday.

Despite numerous cuts to programs, the state estimated its Medicaid budget would run $3.6 million into the red by June 30, according to a letter Friday to doctors, hospitals and other medical personnel who treat Medicaid patients.

To avoid busting its budget, the state's Medicaid Assistance Bureau decided to do away with some services temporarily, ax some for good, reduce payments and otherwise restrict services.

The first of the cuts takes effect Jan. 1, when patients needing to rent a wheelchair, hospital bed or special shower and commode chair will have to have submit those requests for review.

Other cuts include:

A permanent end to Medicaid reimbursement for circumcision, breast reduction surgery and gastric bypass surgery, a radical surgery for the critically obese that reduces the size of the stomach.

Physical, speech and occupational therapy will now have a 40-hours-per-year cap. Claritin, an allergy medicine now available without a prescription, will no longer be covered.

Ending circumcisions was expected to save $25,378.

Some of the cuts are only temporary, expiring in July, the beginning of a new fiscal year. Those include: No more dental care for anyone over 21, except to treat pain. No more prostheses, hearing aids, eye glasses and other medical items for people over 21.

The state is reducing its payment to hospitals by 5 percent temporarily.

Ending dental care was expected to save $291,531. Ending coverage for prosthetic limbs and other equipment was expected to save $193,750.

The department also made other cuts in the amount of money they will pay to Medicaid providers such as doctors and hospitals and made it more difficult to qualify for Medicaid. They also transferred several hundred thousand dollars from other pots of money within the state Department of Public Health and Human Services' budget.

The last cut to hit is a reduction in the amount of money Medicaid will pay for generic drugs, reducing how much the government covers from 85 percent of the average price to 75 percent. That goes into effect April 1.

Because Medicaid is funded by federal matching dollars, the state's $3.6 million in cuts actually amounts to a $13.3 million hit to the program, the letter stated.

Jeff Buska, Medicaid Bureau chief, said several doctors panels considered a variety of procedures, like circumcision and breast reduction, and concluded that they are not medically necessary.

Consequently, Buska said, the agency decided to cut coverage for those services.

"Circumcision is something we've been looking at for a long time," he said.

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