NATIONAL SNAPSHOT SUMMARY

Alabama--has no spend down; an aged/disabled level of only $637/mo (the SSI rate), a working parent level of only 26% (2007) & an ADAP level of 250%; covers only 12 MD visits & hospital days/yr & 4 brand Rx’s/mo; and has an ADAP “enrollment cap”. The budget is short $784 million, so Gov. Riley (R) asked the legislature (D) to cut CHIP $7.3 million & ADAP $5 million; reduce home care benefits and may even close CHIP to new patients. The risk pool has no low income premium discount or Medicare supplement.

Alaska---this Title XVI state has no spend down; has an aged/disabled level of about $999 (its SSI/SSP rate), a working parent level of 81% (2007) & an ADAP level of 300%; tightened HCB & home care medical qualification rules; has a risk pool with a Medicare supplement but no low income premium discount; created a token SPAP for those under 175% that excludes the disabled; and added coverage of some adult dentistry. Gov. Palin & the legislature (both R) raised the CHIP level---but only to 175% of the 2007 FPL. 

Arizona—has no spend down & no risk pool. It covers all parents under 200% & all  childless (even non-disabled) adults under 100% & has an ADAP level of 300%. The  legislature (R) is considering cutting the 200% CHIP level to 175%. Gov. Napolitano (D) started to pay Pt. D co-pays for dual eligibles. The budget is short $1.9 billion.

Arkansas---has an aged/disabled level of $637/mo (the SSI rate), a working parent level of 18% (2007), an ADAP level of 500% & a monthly numerical Rx limit. A waiver funds insurance for small firm workers under 200%.  Gov. Beebe & the legislature (both D) raised DDS fees & covered most adult dentistry. The risk pool has no low income premium discount or Medicare supplement. The state may raise the CHIP level from 200% to 300%, but there’s a budget shortfall                           

California--The risk pool (often closed to new patients) has no low income premium discount (but a bill to start offering  one passed the House) & no Medicare supplement. Public Citizen says MD fees are the US’ 10^th lowest. The state covers the aged/disabled under about 135%, parents below100% & prostate cancer patients under 200%. Its ADAP level is 400% & its CHIP level is 250%.Gov. Schwarzenegger (R) stopped paying extra Medicare HMO premiums for dual eligibles; & continued covering birth control & screening for women under 200%. He & House (D) leaders agreed on a bill to cover all children below 300% (but CMS’ cap is now 250%) & all (even childless & non-disabled) adults under 100%-150% via MediCal; and to subsidize insurance for others below 400%--but a $16+ billion deficit convinced a Senate (D) panel to kill it. He proposed to cut MediCal $1 billion, raise cost-sharing; end adult & reduce CHIP dentistry; make clients re-apply 4 times a year; and cut adult podiatry, hearing, vision & ADAP benefits. He cut provider fees 10% & sought $1 billion+ more in cuts—e.g., slashing the 2 person MediCal level to 61%; reviving the 100 hrs/mo work limit (which would end coverage for many parents); limiting legal aliens to emergency, pregnancy, nursing home & breast/cervical cancer care; and cutting personal attendant care for 84,000 disabled. But he plans to revisit health reform.

Colorado---has no spend down. The old GOP legislature weakened insurance benefits minimums & promoted health savings accounts (HSAs) in private plans. Referendum-voted tobacco taxes boosted the CHIP level to 200%, opened 600 more HCB & Katie Beckett waiver slots & raised the working parent level to 66% (2007). The aged level is about $662 (the SSI/SSP rate only for those over age 60) & a mere $637/mo (the SSI rate) for the younger disabled. The ADAP level is 400%. The Denver Medical Center & the Univ. of CO Hospital cut their indigent care programs; and they & the state Indigent Care plan (for the childless poor awaiting SSA disability awards) boosted their co-pays. The state raised the risk pool’s low income premium discount income level to $50,000 & added a Medicare supplement to it; raised provider fees $28 million; told the Medicaid agency to adopt a consumer -run board’s care plan for the disabled; and got the Kaiser health plan to add $2.5 million more to a fund that subsidizes its poor subscribers’ co-pays. Gov. Ritter (D) adopted a formulary & joined a multi-state Rx buyer pool; and signed bills to create an Rx discount plan for those under 300% & make private plans cover PTSD, anorexia, substance abuse & colorectal cancer screening. A reform panel proposed raising the parent level (and maybe later other adults’ too) to 205% & CHIP’s to 250%; and premium subsidies for others under 400% (cost: $1.3 billion); but Ritter opposes new taxes. See www.colorado.gov/208commission  The legislature (now D) later raised the CHIP level to 225% & widened its mental health benefit; and the Senate pledged to cover all children by 2010 (cost: $200 million). GOP legislators called for spending $8.6 million more to cut a DD services waiting list of 4,000. The Denver Med. Center system, spending half its budget on free indigent care, is short $16-$75 million.

Commonwealth of the Northern Marianas—federal law caps its matching rate far below what states get & it can’t even fully fund its own share of Medicaid costs even though 37% of residents are poor enough for Medicaid. Low fees attract far too few providers (and mostly only public clinics). The territory did enroll some off-island specialists, but only by agreeing to pay them Hawaii Medicaid rates. Its largest hospital has a $32 million deficit due to its low Medicaid fees.

Connecticut—a 209(b) state; its aged/disabled level is about $805 (its SSI/SSP rate), its parent level is 185% & its ADAP level is 400%; its risk pool has a low income premium discount for those under 200% but no Medicare supplement. Gov. Rell (R) added MD visit co-pays; raised premiums, co-pays & asset levels for the SPAP (its income levels are $22,300 for 1 & $30,100 for 2); ended adult chiropractor, naturopath, psychologist, occupational, physical & speech therapy coverage; but seeks to add hospice services for non-Medicare patients. The legislature (D) covered the working disabled & “ex-disabled”; raised the CHIP level from 300% to 400% (but CMS’ new cap is 250% & Rell wants to enroll its patients in HMOs); added low income clinic & hospital “hardship” funds; raised fees to Medicare’s rate (DDS fees remain too low); and made private plans let children stay covered to age 26. A dispute on file & data access caused 3 HMOs to drop state contracts, leaving many patients with access problems. Rell vetoed the legislature’s bill to let towns, cities, non-profits & small firms join the state worker health plan; cut the AIDS services budget by $400,000 & the SPAP by $2.8 million; but, despite calls for a delay to shore up CHIP first, she’ll begin subsidizing insurance for adults under 300% in 7/08. (Yet plan co-pays & premiums are too high, its psychiatric care is too limited; and its caps on Rx & equipment costs, even after being raised, are too low). A bill to drop QMB’s asset test & raise its income level to 220%--and thus also qualify SPAP clients for full Part D Extra Help--died in the legislative rush, but will be re-filed next session. There’s a budget deficit.

Delaware---has no spend down or risk pool; covers all (even childless & non-disabled) adults under 100%, & has an ADAP level of 500%, a CHIP level of 200% & a SPAP level of 200%. Gov. Minner (D) & the legislature (D Sen; R House) started a cancer care program for those under 650% & a state health plan for others under 200%. She proposed to cover CHIP parents, raised provider fees & covered the working disabled. The state expects a shortfall.

District of Columbia---has no risk pool. Income levels are 200% for parents, 100% for the childless aged & disabled, 300% for CHIP (yet CMS’ cap is now 250%) & 400% for ADAP. DC’s own local non-federal health program covers all others under 200%. Mayor Fenty & the Council (both D) covered adult dentistry; raised substance abuse funding & dental fees (but overall provider rates are still too low); raised the aged/ disabled asset level $2,000 & the QMB income level to 300% (thus qualifying many more Medicare patients for Pt D’s full Extra Help); and now seek CMA approval to drop QMB’s asset test. DC is also considering subsidized insurance for those under 200-300%, to be partially funded by a $5 million Blue Cross/Blue Shield donation. When that non-profit plan failed to do so pursuant to its legally-required charity donation rule, DC sued it to enforce that legal obligation. A consultant study urged DC to spend $90 million in tobacco funds on expansion (www.rand.org/research_areas/health ). There’s a deficit & 4 audits cite the misspending of millions.

Florida---Ex-Gov. Bush & the legislature (both R) outsourced eligibility; and got a waiver to privatize Medicaid & move it, with premium support & HSAs, toward a “defined contribution” plan. GAO questioned the quality of Medicaid HMO care & a class action suit was filed against the HMO program. The state’s risk pool is closed to new patients (yet it has a Medicare supplement but no low income premium discount). The state cut the aged & disabled level from 88% to the $637/mo SSI rate, but grandfathered-in those under 88% who are in HCB care or aren’t on Medicare. The working parent level is only 58% (2007) & the ADAP level is 300%. The state covers dentures (but little other adult dentistry) & hearing aids. Providers are suing to raise low fees. Gov. Crist (R) vetoed a mandate to use brand name transplant Rx’s; signed bills to cut $233 million from Medicaid (and $164 million from nursing homes) to meet a $3.4 billion deficit & make private plans cover autism care; started an Rx discount plan; and cut HMO fees $60 million. He proposed more outreach, funding 14 local primary care programs and letting “children over the CHIP 200% level buy into it at full-cost. The legislature passed his bills to make private plans let children stay covered until age 30; gut the insurance minimum benefits law; and sponsor cheap, private, barebones adult insurance. The legislature voted to drop hospice & cut dialysis care; deny nursing home fee raises; offer hospitals a $66 million cushion; and cut Medicaid $803 million more. The state proposed to shift $75 million in LTC costs to counties. Waiver details are at www.hpi.georgetown.edu/floridamedicaid

Georgia---has no risk pool. Its aged/disabled level is only $637/mo (the SSI rate), its working parent level is only 53% (2007), its ADAP level is 300% & its CHIP level is 235%. It has a monthly numerical limit on Rx’s; ended CHIP dental surgery coverage; cut its pregnant woman level to 200%; raised CHIP premiums; ended coverage of adult emergency dentistry & artificial limbs & nursing home spend downs; and tightened Katie Beckett waiver admission rules. Gov. Perdue & the legislature (both R) plan to raise co-pays & foster HSAs and enrolled most patients in managed care (but allow opt outs, due to many consumer & provider complaints); and ended 90 day suspensions for late CHIP premiums. Provider fees are too low & added eligibility red tape cut the rolls 60,000 in 2006. Atlanta’s safety net Grady Hospital is short up to $490 million. A foundation offered it $200 million—but only after Grady’s public board is “privatized”. Also, Savannah’s safety net Memorial Health Univ. Hosp. is short $30 million due to indigent care. The state found $58 million to subsidize GA hospitals’ trauma care--but Grady got only $12.7 million of it, even as Fulton Co. ended its $10 million ambulance subsidy. Perdue sought $55 million more to raise provider fees (which they say are still too low); and signed a bill to subsidize insurance for low wage small firm workers. Firms & workers will each pay discounted premiums---which critics say are still unaffordably high---for a “basic”, high deductible plan requiring patients to make HSA deposits.

Guam—this territory’s matching funds are capped by law far below what states get. Its  non-federal medically indigent plan (MIP) pays even less than Medicaid & attracts almost no private providers. Scanty funds for off-island specialty care, and air transport to it, get used up quickly; and the legislature may ask CMS to let its Medicaid & even Medicare patients use providers in the Philippines. Provider fees are paid too low & too late; and only 1 dentist accepts any Guam patients.

Hawaii—a 209(b) state with no risk pool; a waiver covers all non-Medicare adults below 200%, but childless aged & disabled must be under 100% & the ADAP level is 400%. The state makes all employers insure employees & dependents and created a token SPAP for aged & disabled patients under 100%. Gov. Lingle (R) & the legislature (D) raised the CHIP (to 300%, but CMS’ cap is 250%) & parent (to 250%) levels; cut CHIP premiums & let “over-income” children get it for full-price premiums; restored some adult dentistry; expanded substance abuse care; and found $8 million to raise MD fees in 2009. Public hospitals are short $49 million due to low Medicaid fees & they asked the state for $25+ million. Advocates question state plans to give an HMO contract to an inexperienced Mainland firm with no HI provider network

Idaho---a Title XVI state, with no spend down; an aged/disabled level of only about $669 (the SSI/SSP rate) , a working  parent level of only 42% (2007); an ADAP level of 200%; and a risk pool with no Medicare supplement nor low income premium discount (although adding one is being considered). The GOP legislature raised the CHIP level from 150% to 185%; began a subsidized pilot health plan for low income adults & small firm workers (but it has a big, unused surplus & is under-subscribed); covered the working disabled; and got CMS approval to have 3 patient classes: Parents & children; the disabled & chronically ill; and the aged--who may later get differing benefits, but also more preventive care. Gov. Otter (R) covered adult dentistry, piggybacking on private dental plans’ provider networks to enhance patient access. 

Illinois---this 209(b) state’s aged/disabled level is 100% but its main SPAP excludes the disabled, who get only a limited formulary from a 2^nd,SPAP (both have 200% levels). Gov. Blagjoevich & the legislature (both D) added HIV drugs to the latter’s formulary (only for Medicare patients); and he & the Senate are expected to agree by November to some form of a House-passed bill to give all disabled full, equal benefits in the main SPAP. They raised the parent level to 185%; set the ADAP level at 400%; agreed to a court order to raise pediatric fees (but other provider fees are still too low & paid very late: Auditor Gen. Holland says the bill backlog is $1.5 billion); subsidized insurance for veterans left uncovered by VA cuts; raised the CHIP level; and enrolled 4,000 more MDs to treat children. The risk pool, often closed to new patients, has a Medicare supplement but no low income premium discount. Blagjoevich first proposed raising the parent level to 300% & CHIP’s to 400% (but CMS’ cap is now 250%), keeping it at just 100% for the childless aged/disabled (but now also even for non-disabled adults; and subsidized insurance for others under 400%. The Cook Co. Hosp. system is short $150 million-- forcing service cuts, facility closures, denial of free care to indigent suburbanites & imposition of Rx co-pays. The Governor later scaled back his plan to $1 billion--with only a 3% “fee” on firms with no health plans; no new business taxes; fully subsidizing only those under 100%; with lesser subsidies & more cost-sharing for those over 100%; and premium subsidies only up to 300%. When the legislature ignored this 2^nd plan too, he unilaterally shifted $500 million from budget “pork” to fund it & began enrolling patients in it. But advocates had to lobby for a fix-it bill to cover childless, non-disabled adults too, since the Governor’s own 2^nd plan---which he says costs only $20 million a year & is more than paid for by $34 million saved by his PCCM & chronic care programs—covers only adults who are parents so far. A legislative panel voted twice to kill the plan; a state court barred more enrollment (which Blagjoevich obeyed, but he is appealing); and the deficit is $395-$750 million. He’s resisting forcing clients into HMOs (it has been voluntary), yet raised the working disabled level to 350% & required that Medigap policies be sold to the disabled as cheaply as the costliest aged policies. Local & Senate leaders proposed a Cook Co. Hosp. rescue plan. The Governor will sign a bill to give $640 million/yr to hospitals with big Medicaid caseloads (including $51 million/yr for the Cook Co. Hosp. system).    

Indiana---this 209(b) state’s token SPAP for those under 150% excludes the disabled; and it retains a much-stricter-than-SSI “209(b)” Medicaid disability rule (one must be fatally or incurably ill). Gov. Daniels (R) & the then-all-GOP legislature raised CHIP premiums & added an “enrollment cap” to ADAP (which has a 300% level), yet let Medicare patients enroll in the risk pool (which now has a low income premium discount) for secondary coverage. The ACLU filed suit against a once-every-6-years denture & relinings limit. A $1 billion welfare, food stamp & Medicaid eligibility privatization replaced 1,500 state caseworkers with private firm workers; but it would be limited to only 1 year by the now-Democratic state House. The state tightened its lax spend down (but a court reinstated 12,606 clients dropped without hearing rights); offered service plans & HCB care to 3,350 disabled of the 15,000 on the HCB waiting lists); and will raise MD fees 25% (plus primary care “bonuses”, if CMS agrees). The legislature passed bills to raise CHIP’s level from 200% to 300% (which CMS capped at 250%) and subsidize insurance for all adults below 200% (including up to 37,000 childless adults except Medicare patients; since the aged/disabled level—now under $620/mo, the US’ 2^nd lowest---won’t rise). The insurance includes HMOs, HSAs, preventive care, few co-pays but no dental or vision care). Patients must put 2%-4% of income into HSAs. See http://www.cbpp.org/1-24-08health.htm for more. A state health reform board suggested an insurance mandate, an employer play-or-pay law &, more coverage subsidies. The state expects a shortfall.

Iowa---a waiver covers up to 30,000 non-Medicare adults—even if childless or non-disabled—under 200% for care at 2 public hospitals (with Rx’s dispensed only at their pharmacies). The regular aged/disabled level is only $637/mo (the SSI rate), the working parent level is 89% (2007) & the ADAP level is 200%. The risk pool has a Medicare supplement but no low income premium discount. Gov. Culver & the legislature (both D) chose a health study board that proposed—and the legislature is expected to favor---a mandate to insure all children & a plan to cover all adults publicly or privately by 2012.. The deficit is $350 million. Hospital, MD & DDS fees are too low. Culver made insurance reforms & signed bills making private plans let children stay covered until age 25, covering disabled children through the FOA (but only up to 300%) and raising the CHIP level from 200% to 300% (over CMS’ new 250% cap).

Kansas---a Title XVI state with an aged/disabled level of only $637/mo (the SSI rate), a working parent level of 34% (2007) & an ADAP level of 300%. The GOP legislature passed a bill promoting HSAs & raised provider fees to 65%-83% of Medicare rates. Blue Cross & a foundation subsidize insurance for KC-area families under $30,000. The risk pool has no low income premium discount or Medicare supplement. Gov. Sibelius (D) covered the working disabled, ”ex- disabled” & some “pre-disabled”; and signed bills to extend Medicaid (by 2009 to parents under 50% & by 2012 to all adults under 100%) & study insurance subsidies for those under 200%. The state raised the CHIP level from 200% to 225% by 2009 & to 250% by 2010. There’s a $55 million shortfall & the Senate voted to drop the parent level increases

Kentucky--- has an aged/disabled level of only $637/mo (the SSI rate), a working parent level of only 64% (2007) & an ADAP level of 300%. Ex-Gov. Fletcher (R) & the legislature (R Senate; D House) dropped tough, yet unworkable nursing home & HCB medical admission rules. CMS approved a cap of 4-Rx’s-a-month, limits on occupational /physical/speech therapy visits, x-rays & MRIs; and higher co-pays. The state set up 4 Medicaid groups: “healthy” adults; children; the aged & disabled; and MR & DD patients--with different benefits & more cost-sharing: See http://www.kff.org/7530.cfm . The state started shifting 2,500 disabled into HCB care; and raised child DDS fees (but overall provider rates are still too low). The risk pool has no low income premium discounts or Medicare supplement. Gov. Brashear (D) faces a $266 million deficit, yet expects Medicaid costs of $112 million more in 2008, $147.9 million in 2009 & $242.5 million in 2010. “In the Dark”, a report at www.kyyouth.org, finds that the state offers poor communication & service to its patients.

Louisiana---has an aged/disabled level of only $637/mo (the SSI rate), a working parent level of only 20% (2007) & an ADAP level of 200% It cut covered Rx’s to 8 monthly (over-ride-able by MDs). Its risk pool has no low income discount or Medicare supplement. CMS has offered the state little permanent post-hurricane aid. The legislature (D) raised  CHIP’s 250% level to 300% (capped by CMS at 250%) , voted to cover chiropractic (with fees above those for MDs & over GOP Gov. Jindal’s opposition)  & sought a waiver to cover CHIP parents in New Orleans & Lake Charles--and maybe later even childless adults too. It voted to seek & use significant federal funds for a new safety net hospital in N.O. to replace its destroyed State Charity Hospital--to which Jindal later agreed in principle. He is considering an insurance mandate for those who can afford premiums and a business group’s plan to divert half of DSH---and even some Charity Hosp.---funds to subsidize privatized insurance for non-Medicare (even childless & non-disabled) adults under 200%. A House panel agreed to shift more hospital indigent funds from N.O. to other locales. The Charity Hosp. system is short $35 million.

Maine---Gov. Balducci & the legislature (both D) subsidize “Dirigo” insurance for those under 300% (yet premiums were at first too high & the plan was under-funded & under-enrolled in) and raised the childless adult Medicaid level to 125% (but new non-disabled, non-aged applicants are excluded) & for parents to 200%; have an ADAP level of 500% a CHIP level of 200% & SPAP levels of $1,476/mo for 1 & $1,978/mo for 2 and give O/P waiver coverage to HIV+ (even “pre-disabled”) patients under 250%. There’s no risk pool. Balducci sought to save $74 million with “cost controls”, mental health fee “standardization”, chronic care upgrades; having Medicaid patients get primary MDs; raising some Rx co-pays; an insurance mandate on those over 400%; an employer “play or pay” rule; reforming hospital funding; and starting risk pool & reinsurance plans. Dental fees are too low & paid too late and adult dentistry is limited (e.g., no dentures). With a $124 million deficit, Baldacci sought to raise cost-sharing for those over 150%, to cut podiatry care & to end Rx benefits for childless adults (even those not on Pt. D); but did impose $25 premiums on “richer” patients. He signed bills raising alcohol, soda & insurance taxes to shore up the Dirigo plan and to allow some easing of its premiums & cost-sharing.  

Maryland---has an aged/disabled level of only $637/mo (the SSI rate), a current working parent level of only 37% (2007) a CHIP level of 300% (yet CMS now has a 250% limit) & an ADAP level of 500%. The AARP & Legal Aid got a court order to widen strict ICF & HCB medical admission rules & administrative appeals. A waiver merged the main SPAP with a state O/P clinic program into one for all non-Medicare adults (even childless & non-disabled) under 116%. A new law allows the state-sponsored, Blue Cross-run 2^nd SPAP (which previously only partially subsidized Pt. D premiums for the aged under 300%) to now also cover some of their donut hole costs, but it still excludes the disabled. Provider fees are too low. One child’s untreated tooth infection spread to his brain & killed him, so UnitedHealth funded an indigent child treatment program at the state dental school. The risk pool has low income premium discounts for those under 200% but no Medicare supplement; and the state covers the working disabled. In 2005 a state insurance board let small firm health plans with 500,000 subscribers cut Rx coverage. Gov. O’Malley & the legislature (both D) made private plans let children stay covered dependents to age 26; raised the income level to 116% for full Medicaid, first for parents –and, only via a 5 year benefits phase-in, for childless adults too-- if a slot machine referendum passes & raises enough funds; voted $30 million yearly to subsidize insurance for low paid small firm workers; and gave $50 million to Prince Georges Co. Hosp.(it’s short $300 million since 1/2 its patients get free indigent care). O’Malley & a legislative budget panel later cut Medicaid $40 million; reduced funds to subsidize coverage for low paid small firm workers; and delayed the parent expansion to 116% until at least 1/1/09—yet he & the legislature began to fund a $42 million child dental fee raise and Lt. Gov. Brown’s (D) plan for the state to guarantee mental health access/care to war veterans not promptly served by the VA

Massachusetts---has no risk pool. Ex-Gov. Romney (R) signed the legislature’s (D) bill to expand Medicaid; require everyone to have insurance; subsidize it for small employers & workers under 300%; raise the CHIP level from 200% to 300% (above CMS’ new 250% limit); and raise the parents’—but not the childless aged (now 100%) & disabled (now 133%) –Medicaid level to 200%. The ADAP level is 488% & the SPAP’s is 188%. Gov. Patrick (D) cut the poor’s cost-sharing & dropped deductibles for “Free Care” patients under 200%--but kept its co-pays. Sign-ups of 300,000+ for subsidized coverage helped cause a $1.2 billion deficit, moved a state health board to raise plan premiums & cost-sharing; convinced Patrick to seek $153 million more for the plan; and widened support for adding revenue to meet rising costs. See “On the Road to Universal Coverage…”at www.urban.org for a new analysis of the state’s health reform. Advocates, opposed by business groups, seek to widen the private plan minimum benefits law to cover more mental health services.

Michigan---has no risk pool; an aged/disabled level of 100%, a working parent level of only 61% (2007), a CHIP level of 200% & an ADAP level of 450%. It ended most adult dental, hearing aid, podiatry & chiropractic care and stopped enrolling childless non-disabled adults under 100% into its O/P care-only waiver. Gov. Granholm (D) & the then-all-GOP legislature added cost sharing --but restored adult dentistry; and raised fees for children’s dental & wellness and adult preventive care. Genesee (Flint), Ingram (Lansing), Muskegon & Wayne (Detroit) Counties subsidize coverage for workers under 200%. With a $1.7 billion deficit, Granholm & the legislature (R-Sen; D-House) passed big tax increases & big cuts, but there’s still a shortfall. Signature-gathering failed for a referendum to guarantee coverage for all residents. The legislature is considering a risk pool; but the GOP Senate voted to deny Medicaid to 19 & 20-year-olds.

Minnesota---this 209(b) state has an aged/disabled level of about 100%, a parent level of 275%, a CHIP level of 275%, an ADAP level of 300% and a risk pool with low income premium discounts for those under 200% & a Medicare supplement. It raised premiums & co-pays for Medicaid, CHIP & Minnesota Care (subsidized insurance for the non-Medicare childless under 250% & parents under 275%), cut the latter’s income levels and denied Medicaid & CHIP to legal aliens. The state ADAP imposed premiums on clients over 100%. Gov. Pawlenty (R) funded an Rx discount plan for uninsured & Pt D donut hole patients; and covered the working disabled, “ex-disabled” & some “pre-disabled”. The state expanded child Medicaid; will end most Medicaid co-pays by 2009; and raised LTC fees 2%. The legislature (now D) raised the mental health budget $34 million & forbade hospitals from pre-screening patients for delinquent medical debt. After a bipartisan panel offered a reform plan; Pawlenty hesitated but eventually signed a bill to raise the childless adult MinnesotaCare income level to 250% & cut its premiums and to promote small firm health plans & reform health plan administration. With a $935 million deficit, the state cut hospital---but not nursing home—rates by $90 million.

Mississippi---has no spend down; its risk pool has no low income premium discounts & no Medicare supplement. Gov. Barbour (R) cut the aged/disabled level from $1,000+ to $637/mo (the SSI rate). There’s a working parent level of 32% (2007), a CHIP level of 200% & an ADAP level of 400%. Rx’s are limited to 2 brand names + 3 generics monthly (HIV patients get 5 brand Rx’s & there’s a suit against the limits); and cut physical, speech & occupational therapy. An in-person re-application rule forced 70,000 off the rolls, but Barbour & the Senate (both R) won’t drop it (except maybe for LTC & housebound patients). CMS banned further use of a dubious state funding scheme; now Medicaid needs $86-90 million more in 2008—plus $168-268 million in 2009 (extra federal Katrina funds are now exhausted). Barbour & the Senate (both R) threaten to cut Medicaid $365 million if their hospital tax plan isn’t passed; but many House (D) members instead favor more alcohol & tobacco taxes & using some state rainy day funds (which Barbour says he’d veto)

Missouri---a 209(b) state; its risk pool has no Medicare supplement but has a low income premium discount. Gov. Blunt & the legislature (both R) cut the aged/disabled level from 100% to 85%; ended state medical aid for the poor awaiting SSA disability awards; stopped covering the working disabled; cut the working parent level to 39% (2007); kept ADAP & CHIP levels of 300%; ended adult dental, podiatry, hearing aid & vision benefits (a court voided some DME cuts); raised CHIP premiums & made 46,000 more children pay them; denied CHIP to those with “affordable” job coverage (but exempted those whose job plans cost over 5% of income, have preexisting condition barriers or exhaust covered benefits); restricted medical rules to qualify for LTC; ended CHIP co-pays; raised nursing homes fees; restored wheelchair supplies coverage; and expanded the SPAP (its income level is 150%) to also cover the disabled on Medicare. Blue Cross & a foundation subsidize insurance for KC-area families under $30,000. Blunt cut off Planned Parenthood’s women’s cancer screening funds (because it privately funds abortions). His 2005-06 legislation gives patients health assessments, primary MDs & care plans; allows insurance subsidy pilot projects for adults under 185% in 2 localities; raises & more strictly enforces non-ER co-pays; uses “premium support” to only pay patient job plan premiums rather than let Medicaid be secondary payer; covers foster children until 21; raises MD fees to 62.5% of Medicare rates (Public Citizen said state fees were the US’ 4^th lowest); restores hospice care & some working disabled coverage (while still excluding all but the very poorest); offers birth control & screening to women under 185%; restores adult dental & vision care (but which the GOP legislature later denied to the aged in nursing homes; it also then dropped the restoration of all adults’ dentistry) and hearing aid & podiatry coverage; and lets the aged & disabled opt out of HMOs. A court ordered the state to expand notice & hearing rights before CHIP terminations; and the state allowed presumptive eligibility enrollment of children by low income clinics. Blunt proposed to subsidize insurance for parents under 100% at first; to raise that level to 185% & even include all childless, non-Medicare adults by 2009; but to keep the childless aged/disabled level at only 85%. His plan has no premium & limits cost-sharing for those under 185%; and subsidizes catastrophic insurance for small firm workers under 250%-300%. See “Insure Missouri….” at www.familiesusa.org. But with Blunt not seeking re-election,  even the GOP legislative majority has little interest in his proposals. The Senate (R) did vote for a 225% level for all uninsured non-Medicare adults--but with more cost-sharing & requiring all but the poorest patients to put up to $1,000/yr into HSAs. Democrats instead want to start by restoring the prior aged/disabled (100%) & parent (75%) levels. The Sec of State authorized signature-gathering for a referendum to void earlier Medicaid cuts & raise all patients’ income levels to 200%. The state is replacing 484 caseworkers for 20,000 mentally disabled clients with outsourced, cheaper private ones.

Montana---its aged/disabled level is only $637/mo (the SSI rate), its working parent level is only 60% (2007), its ADAP level is 330% and its risk pool has both low income premium discounts (for those under 150%) & a Medicare supplement. The state raised cost-sharing, and cut LTC & hospice benefits & access and aged & disabled MD visits to 10/yr. Gov. Schweitzer (D) & the legislature (D-Senate; R-House) ended CHIP’s waiting list (but there’s now a short one for ADAP) funded small firm insurance pools; seek a waiver to cover 3,000 more adults; raised Medicaid’s family asset level; started a token SPAP for all Medicare patients under 200%; raised CHIP’s level from 150% to 175%; expanded CHIP dental & preventive care; and made private plans offer vaccines & well-child care to age 7 & let children stay covered to age 25. Officials slated a referendum for 11/08 to spend $20 million to raise the CHIP level to 250% & liberalize child Medicaid.

Nebraska---is a Title XVI state with a one-house non-partisan legislature. Its aged/disabled level is 100%, its working parent level is 58% (2007), its CHIP level is 185% & its ADAP level is 200%. It dropped many welfare-to-work clients & adopted a formulary. The risk pool has a Medicare supplement but no low income premium discount. Gov. Heineman (R) covered Pt. D co-pays for HCB & board & care clients, but plans to cut dental care to $1,000/yr, hearing aids to 1 per 4/yrs, eyeglasses to 1 per 2/yrs, and adults to 12 chiropractic visits and 60 sessions of occupational, speech & physical therapy per year. A study board proposed to make Medicaid a “defined contribution” plan and more use of home care. 

Nevada---a Title XVI state with no spend down & no risk pool; its disabled level is only $637/mo (the SSI rate); the aged-only level is about $673.40 (their SSI/SSP rate), its working parent level is 59% (2007) & its ADAP level is 400%. It covers the working disabled; added coverage of all the disabled to its SPAP (its income level is 225%); added some adult dental & vision care; rejected having Medicaid co-pays; set up a reform study board; but raised CHIP premiums. Gov. Gibbons (R) & the legislature (D-House; R-Sen.) dropped an extra “unearned income“ cap for the working disabled but a $565 million deficit forced them to close CHIP enrollment & cancel a planned $17 million provider fee increase.

New Hampshire---a 209(b) state with a risk pool with no Medicare supplement & no low income premium discount. Its aged/disabled level is about $664 (the SSI/SSP rate), its working parent level is 55% (2007), its CHIP level is 300% & its ADAP level is 300%. Gov. Lynch (D) wants to boost home care options & rates. The state has a stricter-than-SSI “209(b)” Medicaid disability rule (inability to work for 4+ years); doesn’t cover hospices & despite a 65% raise still pays low fees. The legislature (D) delayed plans to bid out women’s & children’s care to distant providers; shifted state LTC costs to counties (which they oppose in a lawsuit); and found funds to end a 3 year DD services waiting list. There’s a $50-$150 million deficit. Lynch called for a hospital rate cut & making private plans let children stay covered to age 26.

New Jersey---has no risk pool, an aged/disabled level of 100%; a parent level of 133%; an ADAP level of 500%, SPAP levels of $31,850 for 1 & $36,791 for 2 and a waiver covering other adults (even childless & non-disabled) under 100%. It privatized eligibility. Gov. Corzine will sign the legislature’s (both D) bills to mandate coverage of all children, raise the parent level to 200% & make private insurance more affordable. Public Citizen said NJ provider fees were the US’ very lowest, so the state tripled many pediatric rates. One audit questions $52 million in school health costs & a 2nd said a hospital indigency fund loses millions to fraud & not seeking out other coverage. Blue Cross now offers very cheap CHIP-like private insurance to children over the 350% CHIP level (which CMS approved years ago). With a $3.5 billion deficit, Corzine & the legislature cut hospital funding $90 million, required $2 Rx co-pays (capped at $10/mo) &, $6 ER co-pays in Medicaid; raised SPAP co-pays; and mandated proof of income & its verification to get Medicaid & CHIP

New Mexico—has no spend down, but has a risk pool with a Medicare supplement & low income premium discounts for those under 200%. Its aged/disabled level is only $637/mo (the SSI rate), its working parent level is 63% (2007), its CHIP level is 235% & its ADAP level is 400%. A waiver funds insurance for small firm workers under 200%. Gov. Richardson & the legislature (both D) raised the child & pregnant woman level to 235%; but awarded mental health care management to a firm that’s s said to cut access & benefits. Low fees reduce access to providers. Richardson proposed (see his pages at www.newmexico.gov ) a semi-“universal” mandate; insurance reforms; raising the subsidized insurance level to 300% or 400% & widening access to it; giving Medicaid to all--even childless & non-disabled--adults under 200%; a 300% CHIP level (above CMS’ new 250% cap); integrating IHS care more with other plans; and even making all providers take state patients---costing $75 million over 5 years & phased in 2009-13 if & as funds allow. The legislature voted only for a 2^nd panel to again study health reform, but Richardson & its leaders are planning a special session later in 2008 to re-visit it

New York---has no risk pool. A “Family Health” waiver offers managed care (with no LTC benefits) to parents under 150% & all childless (even non-disabled) adults under 65 below 100%. The childless aged level is only $725/mo & ADAP’s is 431%. She state subsidizes insurance for workers under 250%, but caps yearly Rx’s at $3,000. The legislature (D House; R Sen.) excludes the disabled from the SPAP (with a 350%+ level); won’t cover digital mammograms; raised Rx & MD co-pays (capping them at $200/yr); adopted an over-ride-able formulary; fosters assisted living, chore aide & adult day care; makes localities pay 1/2 of state Medicaid costs (but caps their yearly increases at 3.5%); let providers deny services to those who don’t meet co-pays; passed slightly tighter nursing home asset transfer rules; funded HIV day health care; covered colon & prostate cancer patients under 250%; required hospital bill discounts for those under 300% & forbade taking homes from delinquent debtors; and passed mental health parity. Public Citizen said MD fees are the US’ 2^nd lowest. Ex-Gov. Spitzer (D) raised the CHIP level from 250% to 400% (above CMS’ new 250% cap); let small firms that can’t afford insurance buy into FamilyHealth at low rates; and began plans to cover ½ the uninsured by 2012. With a $4.9 billion deficit, he sought a $1 billion Medicaid cut (including lower hospital, LTC, home health & Rx fees). Gov. Paterson (D) started an Rx plan (with 30%-50% discounts) for the disabled & those over 50; raised all Medicaid & Family Health asset levels ($13,050 for 1, $19,200 for 2, etc.) & abolished the QMB & SLMB asset tests (children’s & QI asset tests had long been dropped); and signed a budget to protect health funding with an added $1.25-a-pack cigarette tax.

North Carolina---has no risk pool; covers the working disabled; and raised covered Rx’s from 6 to 8 monthly (plus 3 or more via exception).Its aged/disabled level is 100% & its working parent level is 52% (2007). It resurrected a SPAP– which excludes the disabled—to subsidize Pt. D premiums for those under 175% not on full Extra Help. The UNC Hosp. eased its indigent care rules, but asks for up-front cash co-pays. Provider fees are too low--and the Senate (D) voted to cut them $42 million more. The state had made counties pay 15% of Medicaid costs, but Gov. Easley & the legislature (both D) will shift county costs to the state by 7/09. They raised ADAP’s level to 250% & CHIP’s from 200% to 300% (over CMS’ new 250% cap), passed limited mental health parity & created a risk pool (that excludes those on Medicare).

North Dakota---this 209(b) state has a risk pool with a Medicare supplement but no low income premium discount. Its aged/disabled level is 100%, its working parent level is only 63% (2007) & its ADAP level is 400%. A study by the GOP legislature urged a provider fee raise. Gov. Hoeven (R) didn’t seek one, but signed a bill to use the FOA to cover disabled children (but only up to 200%) & raised the CHIP net income level from 140% to 150% (but with very liberal disregards).

Ohio--this 209(b) state with no risk pool cut the parent level from 100% to 90% & has a 500% ADAP level. It slashed adult dental funds 50%; cut secondary fees for dual eligibles; herded most patients into HMOs (some with no infectious disease specialists); slashed medical assistance for 15,000 awaiting SSA disability awards ; let providers turn away those who don’t meet co-pays; and passed mental health parity--but kept its aged/disabled level at only $534/mo (the US’s lowest !). Gov. Srtickland (D) & the GOP legislature raised the CHIP level from 200% to 300% (CMS cut it to 250%), used the FOA  to cover disabled children under 500% & covered foster children to 21. The legislature wouldn’t restore the 100% parent level; but its GOP leaders proposed subsidized insurance for low paid small firm workers. Strickland got a waiver to cover  assisted living & let “over income” children purchase CHIP at full cost. The state cut funds for county eligibility work and an audit said $400 million can be saved by starting a risk pool & reforming nursing home rate-setting. Cleveland’s safety net Metro Health system—where indigent patient numbers doubled--is short $8.9 million. A deficit of $1.3 billion forced Strickland to delay spending $65 million to raise hospital, MD & DDS fees and restore adult dentistry. His health expansion panel suggested Medicaid levels of 200% for parents & 100% for all childless adults (including the non-disabled but possibly not Medicare patients) and subsidized insurance for others under 300%, at a cost of $1 billion.

Oklahoma---this 209(b) state has a risk pool with no Medicare supplement & no low income premium discounts. It cut the aged/disabled level from 100% to about $684 (the SSI/SSP rate). The working parent level is 50% (2007) & its ADAP level is 200%. It ended the parent/children spend down, has a “3-Rx’s-a-month” limit & doesn’t cover hospices. Gov. Henry (D) covered the breast/cervical cancer & working disabled groups, raised tobacco taxes enough to now subsidize insurance for 10,000+ small firm workers/spouses under 200% & raised the CHIP level from 185% to 300% (over CMS’ new 250% cap). The legislature (R-House; even-split Sen.) plans to make Medicaid a defined contribution plan; offer only premium support vs. secondary Medicaid if clients can get job coverage; foster HSAs; gut insurance minimum benefit mandates; and promote primary & home care vs. ERs & nursing homes. It raised many provider fees to the Medicare rate & widened mental health care. There’s a $114 million budget deficit & the state ADAP had to adopt cost-containments

Oregon---this Title XVI state’s risk pool has no Medicare supplement but has low income premium discounts for those under 185%. Its aged/disabled level is only $637.mo (the SSI rate), other levels are 100% for working parents, 185% for CHIP & non-Medicare adults’ subsidized insurance & 200% for ADAP. An anti-tax referendum ended coverage for many adults, ended spend downs (except for transplant & HIV patients), limited adult dental & ended vision care & cut some HMO hospital days to 18/yr. The Oregon Health Plan (OHP) Standard waiver---with limited benefits for uninsured childless non-Medicare adults under 100%---is again taking applications (but it only has enough funds to cover those applicants who win a random lottery). The ADAP reportedly adopted some cost-sharing. Gov. Kungoloski & the legislature (both D) created an Rx discount plan; took the FOA option; raised some home care fees; and named study boards to suggest health expansion plans by 2009. But a referendum to raise tobacco taxes to expand CHIP lost in 11/07.

Pennsylvania---has no risk pool, an aged/disabled level of 100%, its working parent level is only 59% (2007), its CHIP level is 300% & its ADAP level is 350%. It subsidizes “Adult Basic” insurance (with no mental health or Rx benefits & a waiting list of 80,000) for non-Medicare adults under 200%, Its SPAP—with income levels of $23,500 for 1 & $31,500 for 2--excludes the disabled. Gov. Rendell (D) & the old all-GOP legislature cut covered I/P stays to 2 & men’s MD visits to 18/yr; and covered the working disabled & “ex-disabled”. Rendell 1^st sought more tobacco taxes & a 3% payroll tax on firms with no health plans to subsidize insurance for those under 300%. He then dropped the tax (to tap MD malpractice & auto accident pool funds instead) but the Senate (still R) blocked this too. See http://www.phlp.org/Website/alerts.asp  Rendell also proposed to return HMO patients’ Rx benefits to direct state control to bring in $95 million in rebates, to liberalize SPAP & Medicaid Rx access---yet failed to seek SPAP coverage of the disabled. The House (now D) voted to end Adult Basic’s waiting list, cover Rx’s & mental health care, open it to those under300% whose employers help pay premiums & those under 400% who face premium cost & pre-existing condition limits; but keep the Medicare patient exclusion. But Senate (R) leaders oppose this too & instead favor more low income clinic subsidies, business tax credits for HSAs & clinic donations, making private plans let grown children stay covered longer, applying COBRA to firms of under 20 and creating a risk pool. Public Citizen says MD fees are the US’ 5^th lowest. There’s a budget deficit.

 Puerto Rico----federal law caps its matching rate far below what states get. Its HIV care manager denies that its ADAP---which has an income level of 200%--has a waiting list. Advocates dispute that and allege funding & management errors.

Rhode Island---has no risk pool , an aged/disabled level of 100%, a parent level of 185%, a CHIP level of 250% & an ADAP level of 400%. It covers the working disabled but only those disabled over 55 in its limited-formulary SPAP (with income levels of $37,167 for 1 & $42,476 for 2). Gov. Carcieri (R) signed bills to subsidize insurance for low-paid small firm workers (it also guts the insurance mandated benefits law); require free & discounted hospital care for those under 200% & 300%;and ban taking homes from debtors—but sought a 10% O/P fee cut. Public Citizen says MD fees are the US’ 3^rd lowest. With a $450 million deficit, Carcieri first proposed cutting the parent (185% to 133%) & CHIP (250 to 150%) levels; reducing hospital & nursing home fees; and raising cost-sharing. He then sought a lump sum federal waiver payment to meet the current shortfall under which the state would divert 10% of nursing home cases to cheaper home care—but only in exchange for a future federal funding cap that could deny nursing home care to all but the “highest need” patients; raise cost-sharing & require waiting lists. The legislature tentatively approved the waiver (for which it & Carcieri must now find $67 million in savings just for 2009). It voted to drop legal alien children & 7,400 adults. The Human Services Director said funding shortages may require dropping eyeglass benefits & 30,000-40,000 more patients by 2010. See RI Medicaid data at www.povertyinstitute.org ; email lkatz@ric.edu for an analysis of the proposed waiver

South Carolina---has no spend down. Its aged/disabled level is 100%, its working parent level is 100% & its ADAP level is 300%. Its risk pool has a Medicare supplement but no low income premium discounts. Gov. Sanford & the legislature (both R) limited Rx’s to only 4 monthly; added inpatient, ER & outpatient hospital co-pays; offered 2 HSA plans in Columbia; began moving patients to HMOs (allowing opt-outs); and raised the CHIP level to 200%. The waiver-funded SPAP has a 200% level but excludes the disabled. Added state funds ended an ADAP waiting list. There’s a $160 million deficit. Sanford proposed a $22 million CHIP cut & saving $16 million by requiring more generics use. The legislature failed to over-ride his veto of its 50-cents-a-pack tax to fund raising the non-working parent level from 50% to 100% & subsidize insurance for workers below 200%; but did over-ride his veto of a further CHIP income eligibility liberalization.

South Dakota---has no spend down and a risk pool with no low income premium discount that excludes Medicare patients. Its aged/disabled level is only $637/mo (the SSI rate), its working parent level is 56% (2007) & its ADAP level is 300%. A health study board suggested some coverage expansions to Gov. Rounds & the legislature (both R), but he said even raising the pregnant woman level to 200% & CHIP’s to 250% is too costly (tobacco taxes were already raised once).

Tennessee----Gov. Bredeson (D) & the legislature (D House; even split Senate) dropped 191,000 adults, but no children. The aged/disabled level is now $637/mo (the SSI rate), the working parent level is 80% (2007) & the ADAP level is 300%. Except for pregnant women, children & HIV+ patients, MD visits were cut to 10 &, hospital days to 20 yearly; and Rx’s to 2 brand drugs + 3 generics/mo except HIV & Hepatitis C drugs and for drugs to avert death or hospital stays. The state raised pregnant women & infant levels & CHIP’s level to 250%; subsidizes health insurance for small firm workers under 250% (and later maybe others too); revived a risk pool (with no Medicare supplement, but with a premium discount for those under 200%); and started a SPAP to cover up to 5 Rx’s/mo for anyone under 250%. CHIP co-pays are high. Except for also covering insulin, diabetic items & more psychiatric Rx’s, CHIP uses Medicaid Rx rules. CMS allowed only $115 million more for DSH costs in a waiver renewal that also restores the spend down (the Governor then cut spend down funds $80 million & also cut HCB care). There’s a $212 million shortfall, but Tenncare has a $600 million reserve

Texas—has a risk pool with a Medicare supplement & but no low income premium discount. The aged/disabled level is only $637/mo (the SSI rate), the working parent level is only 28% (2007) & the ADAP & CHIP level s are 200%. Gov. Perry & the legislature (both R) ended spend downs & CHIP prostheses, physical therapy & private duty nurse coverage; raised CHIP co-pays & premiums; cut Medicaid home health care; ended adult chiropractic & podiatry care; numerically  limited Medicaid monthly Rx’s; began moving patients into HMOs (but allow opt-outs) and let contracts to privatize eligibility (but contractor failures & patient access problems crippled the plan). A court order to improve children’s care requires $700 million+ in new state spending & a pediatric—but not adult--fee increase. The state restored Medicaid & CHIP mental health, vision & hearing aid coverage & CHIP dental care; gives birth control & health screening to women under 175%; but dropped day treatment. It liberalized CHIP time limit rules, raised car asset limits & disregards child care costs in counting income. It promotes HSAs (allowing opt-outs), required some mental health parity in private plans; and seeks a waiver to use DSH funds to subsidize barebones insurance (2 Rx’s/mo; 5 MD visits & hospital days/yr; high premiums & co-pays) starting with parents under 133% & childless, non-disabled adults under 100%, and--in 3 years--all non-Medicare adults under 200%, if & as funds become available. See http://www.hhs.state.tx.us/Medicaid/Reform.shtml

 Utah--this Title XVI state has a risk pool--with a low income premium discount, but no Medicare supplement. Its aged/ disabled level is 100%, its working parent level is 47% (2007), its CHIP level is 200% & its ADAP level is 400%. A waiver gives O/P care, with big co-pays, to adults (even childless & non-disabled) under 150%. The GOP legislature stopped covering adult dentistry, eyeglasses, podiatry; audiology; speech, occupational & physical therapy; and outdoor wheelchairs, but restored eyeglasses for all adults & dentistry for the aged & disabled. The state may subsidize insurance for 5,000 poor adults & 1,000 children (planned cost-sharing isn’t affordable enough--and for children must be as low as for CHIP). Gov. Huntsman (R) subsidizes job plan premiums of small firm workers under 200%; asked the legislature to “study” raising the CHIP 200% level to 250%; and signed a bill to set up a health reform panel. Provider fees are too low.

Vermont—has an aged/disabled level of 125%, a parent level of 185%, a CHIP level of 300%, an ADAP level of 200% & a SPAP level of 175%. The legislature (D) reversed most of Gov. Douglas’ (R) adult dental cuts (dentures aren’t covered & there’s a $495/ yr cap). CMS approved a waiver that, in return for more funds, puts patients in HMOs & favors HCB care over nursing homes-but also caps future matching. There’s no risk pool but the state subsidizes insurance for those under 300%. There’s a $59 million deficit. Douglas proposed higher Medicaid co-pays & premiums for richer clients, but the legislature (D) prefers lower Medicaid premium boosts & small premium raises for subsidized insurance.

Virginia---a 209(b) state with no risk pool. Its aged/disabled level is 80%, its working parent level is 31% (2007), its CHIP level is 200% & its ADAP level is 300% Provider fees are too low. Gov. Kaine (D) authorized Medicaid for the working disabled & a SPAP for HIV+ Medicare patients under 300%. His health study board urged higher parent (100%) & CHIP (300%) levels, adult dental coverage & subsidized insurance for those under 200%  Even with a now-D Senate, a $1.2+ billion deficit & a still-GOP House led the legislature to agree only to $25 million for low income clinics & some indigent adult dentistry; added pregnancy care & breast/cervical cancer screening funds; $42 million more for mental health; funding 600 (from a waiting list of 4,000) more mentally disabled HCB slots—but also to cut planned hospital & LTC fee raises by $76 million. Kaine dropped plans to limit the formulary for mental health Rx’s; and the GOP House killed a pilot plan to subsidize insurance for workers under 200% (Kaine got private foundation funding instead).

Virgin Islands--its matching rate is far below what states get. Some say its ADAP (with a 400% level) has a waiting list.

Washington--has a risk pool with a Medicare supplement & low income premium discounts for those under 300%; Its aged/disabled level is about $683 (the SSI/SSP rate), its working parent level is 76% (2007) & its ADAP level is 300%. Gov. Gregoire & the legislature (both D); liberalized the subsidized Basic Health plan for non-Medicare adults; restored some adult dentistry; covered Pt. D Extra Help co-pays; passed mental health parity; covered assisted living; raised the CHIP level to 250%; made private plans let children stay covered until 25; and set up another health reform study panel. Providers evicted 75+ assisted living residents because of too-low Medicaid fees, and the state has a $2.5 billion deficit.

West Virginia---has an aged/disabled level of $637/mo (the SSI rate), a working parent level of 35% (2007) & an ADAP level of 250%. It covers only 4 brand Rx’s/mo (+6 generics). Its risk pool has no Medicare supplement or low income premium discount. It cut medical equipment & transport funds; denies adult dental care; and didn’t properly adopt LTC & HCB care medical admission rules. Gov. Manchin & the legislature (both D) raised the CHIP level to 220%; boosted low income clinic funding; started a free Rx plan for all uninsured, non-Medicare adults under 200%; began to assign patients MDs & offer them extra mental health care & Rx’s to sign “personal responsibility” contracts. Only 7.5% did; advocates say the plan is a failure & obstructs access to care. A budget shortfall forced Manchin to seek an $8 million Medicaid cut

Wisconsin---has an aged/disabled level of about $720.78 (the SSI/SSP rate), a parent level of 185% & an ADAP level of 300%. The waiver-funded SPAP (with a level of about 240%) excludes the disabled). The risk pool has a Medicare supplement & low income premium discounts for those under $25,000. Gov. Doyle (D) asked the legislature (R-House; D-Senate) to raise the parent level to 200% & CHIP’s from 250% to 300% (capped by CMS at 250%). The House (R) agreed to raise the CHIP level (71,000 more clients then enrolled)--but not the parent or aged/disabled levels—and to give non-Medicare childless adults under 200% O/P --but not I/P – coverage starting in 1/09. There’s a $652 million deficit

 Wyoming---has no spend down; an aged/disabled level of about $662 (the SSI/SSP rate), a working parent level of 55% (2007) & an ADAP level of 332%; its SPAP covers non-Medicare patients under 100%. The legislature (R) is considering covering CHIP parents under 200%; and expanded CHIP mental health, vision & dental benefits Gov. Freudenthal (D) added a low income premium discount for those under 250% to the risk pool, which also has a Medicare supplement.

SOURCES AND RESOURCES:
 

For the 48 states & DC, the 2008 federal poverty level (FPL) is $10,400 yearly ($866.67 monthly) for one plus $3600 yearly ($300 monthly) for each add’l person; see the Asst. Secy. for Plan. & Eval. pages at www.dhhs.gov for AK & HI.

The 2007 FPL was $10,210/yr ( $851/ mo) for one and $3,480/yr ($290/mo) more for each add’l person .The 2008 SSI rates (not including any state supplements, or SSPs) are $637 monthly for one & $956 per couple.

Email sherry.barber@ssa.gov for  “State Assistance Programs for SSI Recipients, 1/07”(the latest update) on states’ Medicaid eligibility rules for SSI recipients, state supplements (SSPs) & state Sec. 1616, 1634 & 209(b) arrangements.

See www.healthinsuranceinfo.net for a  state-by-state “Consumer Guide for Getting & Keeping …Insurance”; the State Health Expansion Resource Ctr. items at www.familiesusa.org “Medicaid ,SCHIP & Econ. Downturn..” at www.kff.org projecting 1 million more patients in this recession, costing $3.4 billion ($1.4 billion for states);  “How Many Are Underinsured?” at www.cmwf.org , finding that 25 million+ insured have poor coverage; ”Expanding Medicaid..”at www.cbpp.org finding that expansions widening Medicaid coverage are cheaper than purchased private insurance;  and “Fiscal Survey of the States, 2008” at www.NGA.org finding Medicaid costs to still be rising fastest.

See http://www.kff.org/medicaidbenefits/index.jsp  for states’ 2003-06 coverage of  chiropractors, podiatry, dentistry, dentures, orthodontics, eyeglasses, optometry, hearing aids, audiologists, psychologists, prosthetics, hospices, LTC,  home health, medical equipment, prescribed & OTC drugs and physical, occupational, speech & other therapy. The “adult benefit chart” at http://www.medicaiddental.org tabulates state Medicaid coverage of adult dentistry as of 2005.

See guides on blocking bad state plan amendments at www.healthlaw.org. To ensure that  plan changes/waivers get approved by legislatures & not just Governors & state  agencies, see http://www.nachc.com/advocacy/Files/state-policy/model520state520legislationh.pdf & http://www.nachc.com/advocacy/Files/ModelStateLegislation-AppropriationsRiderssr031406_RS-.pdf; a state health reform/expansion guide at www.communitycatalyst.org ; and “Coverage for All: Inclusion of Mental Illness & Substance Abuse..”,  finding that most state expansions, waivers & insurance subsidies offer sub-par mental health/substance abuse coverage at www.healthcareforunisnured.org     

 See “ADAP Watch” at www.NASTAD.org for news of state waiting lists, cost containment measures & state websites.  The “National ADAP Monitoring Report, 2008”, Table XI, at www.kff.org , lists state income & asset  levels; Table XXII charts state policies on Part D; and the Report also covers state cost sharing rules & medical criteria and/or prior authorization needed for special or costly drugs. State ADAP formularies are in a 2nd adjacent document.

States’ 8/03 cost-sharing & premiums are at  http://www.GAO.gov/new.items/d04491.pdf ; but see newer state drug co-pay data in “State Medicaid Drug Reim. 3/05” at www.ascp.com , “Pharm. Benefits [in] State [Medicaid] 2005-6” at www.npcnow.org on formularies, fees, OTC coverage, prior authorization, prescribing/dispensing limits & co-pays; and “Impact of Medicaid Copayment..” on patient Rx access in Medical Care (6/08) at www.lww-medicalcare.com

See http://www.ncsl.org/programs/health/SPAPCoordination.htm , http://www.medicare.gov/spap.asp & “The Role of..[SPAPs After]..Implementation of ..Part D” (7/07) at www.kff.org . Email jcoburn@hdadvocates.org for a chart on how drug makers’ private corporate charity Patient Assistance Programs (PAPs) interact with Part D.

The 6 classes of drugs excluded by Part D can still be covered by Medicaid; such state coverage is re-tabulated from CMS surveys at www.medicareadvocacy.org/Part D_ExcludedDrugsbyState.htm (12/1/05 report under “News” icon).

See “Individual…Models of LTC’ at www.statehealthfacts.org for state coverage of HCB waiver, home health, personal  aides & related care and “Money Follows the Person 101” at www.nsclc.org . Email lsmetanka@nccnhr.org for 2006 state personal needs allowances (PNAs) for SNF/ ICF patients and those in SSP-funded board & care homes. 

See CMS’ letters limiting state CHIP income levels over 250% at www.familiesusa.org ; www.georgetown.edu (Hlth Pol Inst pp) for state waivers to cover parents; and “Determining Income Eligibility..& ..Disregards in Child..Medicaid & SCHIP”(5/08) at www.kff.org for states’ income eligibility levels and disregards for child-only Medicaid & SCHIP.

See www.naschip.org on state health insurance risk pools & websites and to order hard copy of “Comprehensive Health Insurance for High Risk Individuals: A State-by-State Analysis, 21^st Ed.” on state risk pools: funding, eligibility, benefits, any Medicare supplements, premium amounts & any state low income premium discounts.

See” TIICANN materials” under ”what’s new” at www.healthlaw.org for “ Painless Ways To Deal With State Medicaid Budget Shortfalls” to avoid eligibility & benefits cuts;  “State..Aged/Disabled..Income Levels” &  “State.. Parental.. Income Levels”; a health & Medicaid  “Glossary”;  “SPAPs , Part D and..the Disabled”;  “How States Can Make More Patients Eligible for..Full..Extra Help at Little..Cost..”;  and  “2008 VA Health..Benefits”.