Some states cutting Medicaid services to save budget

DENVER -- Paralyzed on his left side from a stroke, Valentin Soskin, 70, has a nurse who delivers eight types of medicine and bathes him weekly.

His 61-year-old wife, Svetlana, has had four operations for cervical and breast cancer since they immigrated to the United States from Belarus in 1994.

Medical bills for the couple, with a combined monthly pension of $1,178, are covered by Medicaid -- benefits the Soskins are about to lose.

Trying to bridge a nearly $1 billion budget deficit, Colorado lawmakers have voted to eliminate Medicaid benefits for an estimated 3,500 legal immigrants -- men, women and children -- who are not U.S. citizens.

"We came here, we liked America, they gave us something to live on, they gave us medicine and now they want to take it away," Valentin Soskin, a former radio factory worker from Vitebsk, said in Russian. "We're like fish being thrown on the shore."

The move is part of a larger effort by at least 29 states to reduce their Medicaid spending as they try to resolve the worst fiscal crisis in more than 60 years. Across the country, hundreds of thousands of poor people could see their Medicaid benefits eliminated or reduced.

"This is a difficult bill that brings into focus the state of our current budget difficulties," said Colorado state Rep. John Witwer, a Republican. "Basically every program that is not mandatory or constitutional is on the table."

Medicaid is seen as a prime target for cutbacks because it typically is the second-largest item in a state budget after education.

Medicaid serves more than 47 million poor, disabled and elderly people and costs $280 billion a year, of which $159 billion is the federal share, according to the National Governors Association. States cover the rest.

Federal requirements

Federal rules require states to offer Medicaid to certain groups such as children in poverty, poor disabled people and poor pregnant women. States also must cover certain immigrants, such as political refugees and veterans of the U.S. military.

But states are free to offer broader coverage, to higher-income people, for example, or more generous benefits, such as prescription drugs and dental care. Colorado, for example, has been extending coverage since 1997 to legal immigrants who have been in the United States at least five years.

About half of the 7,000 immigrants receiving Medicaid benefits in Colorado would be cut off under the new state law. They would still be eligible for emergency medical care.

Health advocates warned that states that cut Medicaid could see higher health care costs later.

"People who get cut off of Medicaid by definition have nowhere else to turn, so if they have health needs they feel aren't immediate, they'll defer seeking care," said Vicky Wachino, associate director of the Kaiser Commission on Medicaid and the Uninsured, a nonpartisan research group. "Some will be fine and some will face problems down the road that they'll need to have seen in the hospital or in the emergency room."

Also, more doctors and hospitals may refuse to absorb the costs of caring for patients without Medicaid, said Ron Pollack, executive director of the consumer group Families USA.

At least 19 states are considering eliminating coverage for certain groups or making it harder to qualify, according to the National Conference of State Legislatures. Twenty states are looking at eliminating or reducing benefits such as glasses, dental care, chiropractic and hospice care.

As of last year, 42 states offered Medicaid to legal immigrants here longer than five years, according to the Kaiser Commission. While some states have reduced such benefits, Colorado apparently is the only state to cut off some recipients altogether, said Lee Dixon of the NCSL.

After Colorado's law was signed in March, Valentin Soskin and seven other immigrants sued. A federal judge upheld the law in April, saying the need for a balanced budget outweighed their health care needs.

The ruling is under appeal, and the law is on hold in the meantime, allowing the Soskins and the others to continue receiving benefits.

The Soskins pay $477 per month for rent and a meal service in their subsidized apartment complex.

"We'll lose Medicaid and lose our medicine. How can you leave two old people like us without medicine?" asked Svetlana Soskin, who worked at a furniture factory in Belarus.

"What's worse, we have no one here to help. We can't call anyone, we don't know anyone. If we are going to spend all our money on medicine, we won't be able to pay for the apartment."

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Associated Press Writer Nick Wadhams contributed to this report.

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On the Net:

Kaiser Commission on Medicaid and the Uninsured: http://www.kff.org/sections.cgi?sectionkcmu

U.S. Centers for Medicare and Medicaid Services: http://cms.hhs.gov