Medicaid's cutting edge

Despite the looming loss of medical coverage this summer, Southeast Missouri's Medicaid recipients aren't exactly racing to their nearest health-care facility to beat the doctor deadline.

Unlike in larger Missouri cities, there are no meandering lines made up of the poor, elderly or disabled trying to get to see a physician or dentist for one last appointment before massive program cuts take effect in July and August.

"We have had some individuals who have called to try to get things taken care of," said Rhonda Fievers, office manager at Dr. T. Wayne Lewis' dental office in Jackson. "Some, but not a lot."

Other medical facilities and dentists' offices in the area said the same.

That's a fact some find surprising, especially considering that when all the cuts go into effect, about 100,000 out of 1 million who are elderly, have a low income or a disability in Missouri will lose medical coverage.

About 60,000 of those will be eliminated because of new income restrictions put in place by Gov. Matt Blunt and the state legislature, which overhauled what they called a bloated system that could be cut to help balance the state budget.

Medicaid previously covered those earning less than 75 percent of the poverty level. Under the cuts, the new cap has been dropped to 23 percent, meaning a single parent with two children can earn no more than $292 a month to be eligible for Medicaid coverage.

In addition, some services are being eliminated from Medicaid coverage entirely. Specifically, services such as dental coverage, foot care and the use of medical equipment will not be paid for by Medicaid.

The deadlines for the cuts are July 1 and Aug. 28, depending upon the service.

And while doctors' and dentists' offices may not be overflowing, some cuts have made Medicaid recipients uneasy.

"It's terrible what they're doing," said Annie Bell, a 38-year-old Cape Girardeau mother of two who is on Medicaid.

Bell was at Cross Trails Medical Center in Cape Girardeau Thursday to have a tooth filled, something Medicaid won't cover for adults after the cuts.

"I heard what they were doing and it made me mad," Bell said. "There are a lot of people who are disabled and can't work. What are they going to do? Everybody needs insurance."

Bell's sentiments aren't isolated.

"Of course some people are worried," said Vicki Smith, CEO of Cross Trails, which provides treatment for underserved, uninsured, under-insured and low-income patients.

Smith said they are seeing an increase from Medicaid recipients wanting to get treatment before their coverage expires.

Nursing home or not

Joane Whitledge, a respiratory therapist at Home Medical Supply in Cape Girardeau, said some of their Medicaid clients have been "very upset" about the cuts. For some, it could mean the difference between living at home or living in a nursing home.

Under a change that takes effect on Aug. 28, Medicaid will no longer pay for durable medical equipment such as wheelchair accessories and batteries, patient lifts, body braces, hospital beds and side rails, commodes, crutches and walkers.

Deborah Scott, a spokeswoman for the Missouri Department of Social Services, said the reductions were necessary to give the state flexibility to balance the budget. Letters were mailed to recipients about lost or reduced coverage.

"We had, as a state, opted into a number of optional services for Medicaid," she said. "Under the changes, we changed the language so we would not be creating mandatory services that were optional at the federal level."

The legislature can now make decisions each year about certain Medicaid services instead of being required to offer those services. If the budget is less problematic in future years, those services can be brought back, Scott said.

On July 1, some people will lose coverage because of new income restrictions. Those who are transitioning from welfare to work will have coverage for another year, but then will lose coverage, Scott said.

In Cape Girardeau County, 501 recipients will lose coverage on July 1. In a year, an additional 533 recipients will lose coverage for a total of 1,034.

In Scott County, 606 will lose their coverage on July 1 and 492 more in a year, totaling 1,098. In Perry County, 161 recipients will lose coverage July 1 and 124 more recipients will lose coverage in another year for a total of 285.

Dr. Bob Fox, a Cape Girardeau dentist who also is president of the Missouri Dental Association, said he has seen some Medicaid patients who have been trying to beat the deadline. Adults on Medicaid will lose their dental coverage on Aug. 28.

But it's not a whole lot, especially considering that many health-care providers don't see Medicaid patients because the government doesn't reimburse health-care providers as much as it costs to treat them, Fox said.

"That's a big problem and it's a statewide problem," he said. "Our overhead is about 60 percent of what we make and Medicaid reimburses about 40 percent."

Some doctors say they are the ones left telling patients they can no longer treat them for certain problems.

Dr. Hugh Protzel, a podiatrist in Cape Girardeau, estimates 10 percent to 15 percent of his practice is made up of Medicaid patients.

In his specialty, the feet, Medicaid patients will no longer be able to get treatment for trimming toenails, removing in-grown toenails or putting a brace on the foot, a common practice in treating athletic injuries.

Those problems may not sound serious, but in the case of a diabetic, it could result in lost limbs. If someone has serious toenail fungus, there is a real risk of losing a body part if left untreated, he said.

"Obviously, a lot of them won't get treated," Protzel said of those who lose coverage. "In some cases, I won't be able to treat them at all."

But Dr. Eric Morton, president of the Cape Girardeau County Area Medical Society, said that the general public shouldn't fear that Medicaid recipients won't receive treatment for serious, life-threatening situations.

"The Medicaid cuts will affect everybody for routine services," said Morton, an OB-GYN. "It's true that will affect certain people. But for emergency services, people will get taken care of irregardless. If somebody comes into the ER bleeding to death, they will get treatment. That's just what you do as a doctor, regardless of ability to pay."

smoyers@semissourian.com

335-6611, extension 137

Medical services reduction under Medicaid

* Comprehensive day rehabilitation: eliminated

* Dental services (including dentures): adult coverage is now limited to treatment for trauma or disease

* Durable medical equipment: eliminated

* Rehabilitation, such as occupational, speech, or physical therapy: eliminated

* Diabetes self-management training: eliminated

* Audiology, which includes hearing aids and associated testing services: eliminated

* Optical services: eliminated, except for one eye exam every two years

* Foot-care services: eliminated

SOURCE: Missouri Department of Social Services