NATIONAL SNAPSHOT SUMMARY

Coverage_expanded_in_AK, CO, CT, DC, FL, HI, ID, IL, IN, MA, MD, MN, NV, NY, NC, OH, OR, SC, TN, TX, UT, VA, VT, WA & WV.

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 CHIP level to 175%. Gov. Napolitano (D) added outreach & 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 only 18% (2007), an ADAP level of 500% & a monthly numerical Rx limit. A waiver funds insurance for small firm workers under 200% but only 700 of an expected 7,000 patients enrolled.  Gov. Beebe & the legislature (both D) raised DDS fees & covered most adult dentistry. The risk pool has no low income premium discount & no Medicare supplement. There’s a state budget shortfall.                            

California--The risk pool (often closed to new patients) has no low income premium discount (but a bill to add has already 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 under100% & prostate cancer patients under 200%. Its ADAP level is 400%. Gov. Schwarzenegger (R) stopped paying extra Medicare HMO premiums for dual eligibles; and seeks continued waiver funds for birth control & screening for women under 200%. He & House (D) leaders agreed on a bill to cover all children under 300% (but CMS’ cap is now 250%) & all (even childless & non-disabled) adults under 100%/150% in MediCal; and to subsidize insurance for others under 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; add eligibility red tape; and cut adult podiatry, hearing, vision & ADAP benefits. He reduced 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. L.A. County’s public clinics face a big shortfall.

Colorado---has no spend down. The old GOP legislature enacted laws to weaken insurance benefits minimums & to foster health savings accounts (HSAs) in private plans. Referendum-voted tobacco taxes increased the CHIP level to 200%, opened 600 more HCB and/or 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 state is moving children into HMOs. The Denver Medical Center & the Univ. of Col. Hospital cut their indigent care programs; and they & the state Indigent Care plan (for the childless poor awaiting SSA disability rulings) raised their co-pays. The state raised the risk pool’s low income premium discount evel to $50,000 & added a Medicare supplement to it; raised provider fees by $28 million; and told the Medicaid agency to adopt a consumer-run board’s care plan for the disabled. 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% and make private plans cover PTSD, anorexia & substance abuse. He favors starting a small employer insurance pool. A health reform panel proposed a semi- universal mandate; raising the parent level (and maybe later other adults’ too) to 205% & CHIP’s to 250%; and subsidized premiums for others under 400% (costing $1.3 billion); but Ritter opposes new taxes, even for expansions. See www.colorado.gov/208commission  The  legislature (now D) later raised the CHIP level to 225% & widened its mental health benefit and the State Senate (D) pledged to cover all children by 2010, but voted no means or funds to do so (it could cost $200 million). GOP legislators favor more use of nurse practitioners & spending $8.6 million more to cut the DD services waiting list of 4,000. The tax-subsidized Denver Medical Center system, spending ½ its budget on free indigent care, is short $16-$75 million 

Commonwealth of the Northern Marianas—federal law caps its matching rates 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 to qualify for Medicaid. Low fees attract far too few providers (and mostly only public clinics). The territory did enroll off-island specialists, but only by agreeing to pay them Hawaii Medicaid rates. Its largest hospital has a $32 million deficit due to 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 to 400% (but CMS’ new cap is 250% & Rell wants to enroll its patients in HMOs); added low income clinic, hospital “hardship” & outreach funds; says it raised fees to Medicare’s rate (DDS fees remain too low); and made private plans let children stay covered to age 26. A dispute with the state about file & data access caused some HMOs to drop state contracts, leaving many state patients with access problems. Rell may veto the legislature’s bill to let towns, cities, non-profits & small firms join the state worker health plan; but she got funds to subsidize insurance for those under 300% starting 7/1/08 (yet co-pays & premiums are too high, psychiatric care is too limited; and caps on Rx &  equipment costs, even after raises, remain too low). A bill to drop QMB’s asset test & raise its income level to 220%--to thus also qualify state SPAP clients for full Part D Extra Help too--died in the legislature, but will be re-filed next session.

Delaware---has no spend down or risk pool; covers all (even childless & non-disabled) adults under 100%, & has an ADAP level of 500%. Its SPAP has a 200% level & caps yearly benefits. Gov. Minner (D) & the legislature (D Senate; 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 & other reforms; raised provider fees; and 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% (an audit says fraudulent enrollment by non-residents may cost $40 million). Mayor Fenty & the Council (both D) covered adult dentistry; raised substance abuse funding & dental fees (but all 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 Part D’s full Extra Help); and are considering eliminating QMB’s asset test & passing “universal” coverage, with insurance subsidies for those under 200% or even 300%. Four audits cite Medicaid mis-spending of 100s 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 still-expanding HMO program. The state’s under-funded 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 aged & disabled under 88% who are in HCB care or who 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 “over-income” children buy CHIP at full-cost premiums. The legislature passed his plans to make private plans let children stay covered until age 30; gut the insurance minimum benefits law & sponsor cheap, privatized, barebones adult insurance; but it killed plans to end grandfathered eligibility under the 88% level for 24,000 HCB waiver clients & non-Medicare aged & disabled and abolish the spend down (20,000 were at risk). The Senate voted to drop hospice & cut dialysis coverage; deny hospital & LTC fee raises; and cut Medicaid by $803 million more. State staff proposed shifting $75 million+ in LTC costs to counties. See data on the state Medicaid program & the waiver 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%. It has a monthly numerical limit on Rx’s; ended CHIP dental surgery coverage; cut Medicaid’s pregnant women & infant level to 200%; raised CHIP premiums; ended adult emergency dentistry & artificial limb coverage and nursing home spend downs; and tightened Katie Beckett waiver admission rules. Gov. Perdue & the legislature (both R) plan to cut nursing home costs, raise co-pays and foster health savings accounts (HSAs). They enrolled most non-institutional patients in managed care (but allowing opt outs, since there are many quality of care, provider fee & access complaints); and ended 90 day suspensions for late-paid CHIP premiums. Provider fees are too low & added eligibility red tape cut the rolls 60,000 just in 2006. The state’s federal ADAP funds will drop $1.5 million, which could bring cuts unless the state makes that up. 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 was “privatized” (the change still depends on more regularization of & increases in state subsidies). Savannah’s safety net Memorial Health University Hosp. has a $30 million deficit, also due to indigent care. The state came up with a $58 million subsidy for hospitals’ trauma care that they’re now vying to divide up (i.e., Grady wants at least $25 million). Medicaid HMOs dropped dentists serving 100,000 children. Perdue proposed $55 million more in state funds to raise providers’ 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 discount premiums---which critics say are 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 local, non-federal medically indigent plan (MIP) pays even less than Medicaid & attracts almost no private providers. Limited funds for off-island specialty care, and air transport to it, get used up quickly; and the territorial legislature may ask CMS to let its Medicaid & even Medicare patients use providers in the Philippines. Provider fees are too low & paid too late and only one dentist accepts any Territorial patients. Local media are reporting MIP and Medicaid funding irregularities and shortages.

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 now 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. Public hospitals are short $49 million due to low Medicaid fees & asked the state for $25 million

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); 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 childless aged, disabled & also even non-disabled adults; and subsidized insurance for others under 400%. The Cook Co. Hosp. system is short $150 million deficit-- forcing service cuts, facility closures, denial of free indigent care to suburbanites & imposition of Rx co-pays; and E. St Louis’ safety net Kenneth Hall Hosp., with a $3 million deficit from indigent care, is closing. The Governor later cut his plan’s cost to $1 billion--with only a 3% “fee” on firms with no health plans; no new business taxes; fully subsidizing only those under 100%; and with lesser subsidies & more cost-sharing for those over 100% (and premium subsidies only up to 300%). After 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 add coverage of childless, non-disabled adults too, since the Governor’s own 2^nd plan---which he says costs only $20 million this year, and says is more than paid for by $34 million saved by his PCCM & disease management programs —covers only parents as yet. A legislative panel voted twice against the plan; a state court barred further enrollment (Blagjoevich obeyed & halted enrollment, but is appealing); and there’s a $395-$750 million deficit. He’s being urged to force patients 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 local/state/federal Cook Co. Hosp bailout plan & county officials are considering more taxes to fund it.   

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 an unspecified 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 patients with no hearing rights); offered service plans & HCB waiver care to 3,350 disabled on the 15,000 on 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 (including up to 37,000 childless ones; but not Medicare patients: the aged/disabled level—now under $620/mo, the US’ 2^nd lowest---won’t rise) under 200%. 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 a critique. 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) raised tobacco taxes to cover 29,000 more patients, and chose a health study board that proposed—and the legislature is expected to vote for--a mandate to insure all children & a plan to cover all adults publicly or privately by 2012 (costing the state $31 million more). The deficit is $350 million. Hospital, MD & DDS fees are too low. Culver proposed insurance reforms & signed bills making private plans let children stay covered until age 25 & raising the CHIP level to 300% (costing $25 million & above 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, ended the SPAP & 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” & signed bills to offer Medicaid-subsidized coverage (by 2009 to parents under 50% & by 2012 to all adults under 100%); fund a 2^nd risk pool; and study other reforms (e.g, insurance subsidies for those under 200%). The state raised the CHIP level to 250% but the Senate voted to drop the planned parent level increase

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; reinstated 2,500 CMI clients; and ended an ADAP waiting list. CMS approved a cap of 4-Rx’s-a-month, limits on occupational /physical/speech therapy visits, x-rays; and MRIs, and higher co-pays. There’ll be 4 Medicaid groups: “healthy” adults; children; the aged & disabled; and MR & DD patients--each with different benefits but higher cost-sharing: See http://www.kff.org/7530.cfm . The state started to shift 2,500 disabled into HCB care; and raised child dental fees 30% (but overall provider rates are still too low). The risk pool has no low income premium discounts and no Medicare supplement. Gov. Brashear (D) faces a $266 million deficit, yet faces expected Medicaid cost increases of $112 million in 2008; $147.9 million in 2009; and $242.5 million in 2010 just to stay even.

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/mo (over-ride-able by MDs); and adopted a formulary. Its risk pool has no low income discount & no Medicare supplement. After hurricanes cut its revenues $1-$3 billion, the state sought more federal aid; but CMS offered little--with even that contingent on closing/privatizing the state Charity Hospitals. Ex-Gov. Blanco & the legislature (both D) raised the CHIP level to 300% (limited by CMS to 250%) & sought a waiver to cover CHIP children’s parents in N.O. & Lake Charles--and maybe later even childless adults. The legislature voted to use $300 million in federal funds to help build an LSU hospital in N.O. to replace its destroyed Charity Hospital, but Sen. Vitter (R) is trying to get HUD to deny funds for it & Gov. Jindal’s (R) staff favors a cheaper hospital. Jindal’s health advisors are  considering reform plans. These include an insurance mandate for those who can afford premiums and a business group’s plan to divert ½ of DSH---and even some Charity Hospital---funds to subsidize privatized insurance for non-Medicare (even childless & non-disabled) adults under 200%, with premiums of $197/mo--which is opposed by many legislators.

Maine---Gov. Balducci & the legislature (both D) subsidize “Dirigo” insurance for those under 300% (yet premiums were at first too high for the poor & it was under-funded & under-enrolled in) and raised the Medicaid level for childless adults to 125% (but now deny coverage to new non-disabled, non-aged applicants) & for parents to 200%; have an ADAP level of 500% and SPAP levels of $1,476/mo for 1 & $1,978/mo for 2 & give limited 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 proposed more cost-sharing for those over 150%, cutting podiatry care & ending Rx benefits for childless adults (even if not on Pt. D); and imposed $25 premiums on “richer” patients. He also signed bills raising alcohol, soda & insurance taxes to shore up the Dirigo plan and 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 waiver admission rules & administrative appeals. A waiver merged the main SPAP with a state O/P clinic program 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 a state dental board called for higher DDS fees &  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 an 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/yr 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 & needs even more state & county funds). O’Malley & a legislative budget panel later cut Medicaid $40 million; reduced funds to subsidize coverage for low paid small firm workers; and delayed expanding parent coverage to 116% until at least 1/1/09—yet he & the legislature added $5 million for infant & toddler care and began funding a total $42 million child dental fee increase.

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 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 state-only “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.

Michigan---has no risk pool; an aged/disabled level of 100%, a working parent level of only 61% (2007) & 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 some cost sharing --but restored adult dentistry; and raised fees for children’s dental & wellness care 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) enacted big tax increases & big cuts, but there’s still a shortfall. Granholm, AARP & labor favor a referendum to guarantee coverage for all residents; the legislature is considering health reforms (e.g., creating 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%, 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 (state-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 & Part 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 & home care fees 2%. The  legislature (now D) raised the mental health budget $34 million & forbade hospitals from pre-screening patients for delinquent medical debt. A bipartisan panel drafted a reform plan, then, after first threatening a veto, Pawlenty 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 may cut hospital---but not nursing home—funding $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); kept a working parent level of only 32% (2007) & an ADAP level of 400%; cut covered Rx’s to 2 brand names + 3 generics monthly (but 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, so the House (D) voted to void it but Barbour & the Senate (R) won’t agree (except maybe for LTC & housebound patients). CMS banned further use of a dubious state funding scheme, so Medicaid now needs $86 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 the House (D) instead prefers more taxes on liquor & tobacco and use of some state rainy day funds (which Barbour says he’d veto).

Missouri---a 209(b) state; its risk pool has no Medicare supplement but now has an unspecified low income premium discount. Gov. Blunt & the legislature (both R) cut the aged/disabled level from 100% to 85%; ended state medical aid & welfare for the poor awaiting SSA disability decisions; dropped coverage of the working disabled; cut the working parent level to 39% (2007); kept an ADAP level 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 then exempted those whose job plans cost over 5% of income); tightened medical rules to get nursing home, HCB & home health care; ended CHIP co-pays; raised doctor & nursing homes rates; restored wheelchair supplies coverage; and expanded the SPAP (its income level is 150%) to 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; begins pilot insurance subsidies for adults under 185%; 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 65% 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 175%; restores adult dental & vision care (if prior authorized--but which the GOP legislature later denied to the aged in LTC; 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. Blunt proposed to subsidize insurance for parents under 100% at first; to raise that level to 185% & even include all childless, non-Medicare adults in 2009 (but 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. With Blunt not running again & no longer effectively backing his own plan, the Senate (R) passed a bill with 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; even split 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 small 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. He favors a referendum 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 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 and board & care clients, but plans to limit 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 health study board proposed making Medicaid a “defined contribution” plan and expanding home health & HCB 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 & raised MD fees to 90%-100% of Medicare‘s 2007 rates. A $565 million deficit has brought a freeze on CHIP enrollment.

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 ADAP level is 300%. Gov. Lynch (D) expanded SCHIP & ADAP; and 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 & the legislature (both D) are considering bills to cover all children, raise the parent level to 200% & offer income-based subsidies to others—with a state mandate). After Public Citizen said its provider fees were the US’ lowest, the state tripled many pediatric rates. CMS approved a 350% CHIP level prior to adopting its new 250% cap. An audit questions $52 million in school health costs & a 2nd said a hospital indigency fund loses millions to fraud & not seeking out other coverage. The state got Blue Cross to offer cheap CHIP-type policies, at no public cost, to “over-income” children. With a $3.5 billion deficit, Corzine proposed cutting hospital charity funding $144 million, requiring Medicaid Rx co-pays ($2/ea, capped at $10/mo) & $6 non-emergency ER co-pays and raising SPAP co-pays.

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 only 63% (2007) & its ADAP level is 400%. A waiver funds insurance for some 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 as & if 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%. State-subsidized insurance for workers under 250% 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, but ex-Gov. Spitzer (D) proposed raising O/P provider rates 75%; 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; stopped counting children’s SSI to cut family welfare checks; won’t force HIV+ patients into HMOs; and told his insurance & health staffs to plan 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 and using more generics in the SPAP). Gov. Paterson (D) created a Rx discount plan (with prices 30% to 50% lower) for the disabled & those over age 50; raised Medicaid & FamilyHealth asset levels ($13.050 for 1, $19,200 for 2, etc.) & eliminated the QMB & SLMB asset tests (children’s & QI asset tests had already been dropped); and signed a budget to preserve health funding with an additional $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 (with some exceptions for 3 or more extra Rx’s). Its aged/disabled level is 100% but its working parent level is only 52% (2007). It resurrected a SPAP– which again excludes the disabled—to subsidize Pt. D premiums for patients under 175% not on full Extra Help. The UNC Hosp. system eased its indigent care rules, but now seeks up-front cash co-pays. MD & DDS fees are too low. The state had made its counties pay 15% of state Medicaid costs, but Gov. Easley & the legislature (both D) passed a law for permanent state assumption of county costs by mid-2009, raised the ADAP level to 250% & CHIP’s to 300% (which is over CMS’ new 250% cap), passed limited mental health parity & authorized planning for a risk pool.

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, but Gov. Hoeven (R) didn’t seek rate increases. He did sign a bill taking the FOA option to cover disabled children (but with an income level of only 200%). A claims-paying backlog grew to $90 million.

Ohio--this 209(b) state with no risk pool cut the parent level from 100% to 90%; has a 500% ADAP level; slashed adult dental funds 50%; cut secondary fees for dual eligibles; moved most patients into HMOs; slashed state Disability Medical Assistance (DMA) for 15,000 awaiting SSA disability awards & barred new DMA applications; 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) got the GOP legislature to raise the CHIP level to 300% (CMS then cut it to 250%), take the FOA option to cover disabled children under 500%; & cover foster children to 21; but it wouldn’t restore the parent level to 100% (yet its GOP leaders did propose subsidized insurance for low paid small firm workers). He found funds to admit 1,100 patients to HCB care, got a waiver to cover some assisted living & let “over income” children buy into CHIP at full price premiums. 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 the number of  indigent patients has doubled--is short $8.9 million. A deficit of $1.3 billion forced Strickland to delay spending $65 million he’d pledged to raise hospital, MD & DDS fees and restore adult dentistry. His health expansion panel was to have reported in May & suggest subsidized coverage for 500,000 more (mostly adults 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 only about $684 (the SSI/SSP rate), the working parent level is only 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 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 a Medicare supplement but has low income premium discounts for those under 185%. Its aged/disabled level is only $637.mo (the SSI rate), 100% for working parents, 185% for 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 non-Medicare childless adults under 100%---is again taking applications (but funding shortages mean that only those who win a random lottery can be covered). 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 for legislative action by 2009. But a referendum to raise tobacco taxes for CHIP expansion lost in 11/07.

Pennsylvania---has no risk pool, an aged/disabled level of 100%, its working parent level is only 59% (2007) & 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 without insurance to subsidize insurance for those under 300%, at no cost for the smallest firms. The plan does not raise the aged/disabled Medicaid level (now only 100%).Then he dropped the 3% tax (to instead tap state medical malpractice & auto accident pools’ funds) but the still-GOP Senate refused to use the malpractice funds. See http://www.phlp.org/Website/alerts.asp  Rendell also proposed to return HMO patients’ Rx benefits to direct state control (saving $95 million), to liberalize SPAP & Medicaid Rx access---yet failed to seek SPAP coverage of the disabled. The House (now D), with some GOP support, voted to reform Adult Basic to end its waiting list, cover Rx’s & some mental health care and open it to those under 300% whose employers help pay premiums & those under 400% who face premium cost & pre-existing condition limits (but the bill keeps the Medicare patient exclusion). Public Citizen says MD fees are 5^th lowest in the US. 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% & 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 a bill to subsidize insurance for low-paid small firm workers (it also guts the insurance mandated benefits law); required free & discounted hospital care for those under 200% & 300% and banned taking homes from delinquent debtors--but sought a 10% outpatient 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---then sought a $561 million cut (specifying only  moving 10% of nursing home cases to home care & raising home care/elder day care co-pays); and still later proposed a waiver with a future federal funding cap that could deny nursing home care to all but those with the “highest” need; raise cost-sharing even more & allow “waiting lists” for some services. The legislature voted to drop legal alien children & 7,400 adults and the state Human Services Director said fund shortages may require dropping 30,000-40,000 patients by 2010. See 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 I/P, ER & O/P hospital co-pays; offered 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; and a legislative panel voted to get $105 million in ”savings” from the human services budget. The legislature failed to over-ride Sanford’s veto of its 50-cent cigarette tax to raise the non-working parent level from 50% to 100% & subsidize insurance for workers below 200%.

South Dakota---has a risk pool with no low income premium discount that excludes Medicare patients and no spend down. 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 recently).

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 many drugs to prevent death or hospital stays. The state raised pregnant women & infant Medicaid levels & CHIP’s level to 250%; subsidizes health insurance for workers under 250% in small firms (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 (which exclude benzodiazepines, even for epilepsy, seizures & mental health). CMS allowed $115 million more for DSH costs (yet $270 million is needed) in a waiver renewal that also restores the spend down (yet the Gov. 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 level is 200%. Gov. Perry & the legislature (both R) ended the spend down & CHIP prostheses, physical therapy & private duty nursing 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--now with an unspecified low income premium discount, but no Medicare supplement. Its aged/disabled level is 100%, its regular working parent level is only 47% (2007) & its ADAP level is 400%. A waiver gives only O/P care, with high co-pays, to uninsured adults, even if childless & non-disabled, under 150%. The GOP legislature stopped covering adult dentistry, eyeglasses, podiatry; audiology; speech, occupational & physical therapy; and outdoor wheelchairs. Provider fees are too low. The legislature restored eyeglass coverage for all adults & dentistry for the aged & disabled only; and set up a health reform panel. Gov. Huntsman (R) subsidizes job plan premiums of small firm workers under 200%; but asked the legislature to merely “study” raising the CHIP level to 250%

Vermont—has an aged/disabled level of 125%, a parent level of 185%, an ADAP level of 200% & a SPAP level of 175%. The legislature (D) reversed most of Gov. Douglas’ (R) adult dental cuts (but dentures still aren’t covered & there’s a $495 yearly cap); and provider fees remain too low. CMS approved his HIFA waiver that, in return for added federal funds, puts patients into HMOs, promotes HCB care over nursing homes & tightens asset transfer bans--but also caps future matching. There’s no risk pool, but the state taxes firms that don’t offer health plans to subsidize insurance for those under 300%. There’s a $59 million state deficit. CMS won’t allow Medicaid matching to subsidize those over 200% because that violates the waiver funding cap. Douglas proposed higher Medicaid co-pays & premiums for richer patients, but the legislature (D) prefers lower Medicaid premium boosts, with small premium raises for subsidized insurance too.

Virginia---a 209(b) state with no risk pool. Its aged/disabled level is only 80%, its working parent level is only 31% (2007) & its ADAP level is 300% Provider fees remain too low. Gov. Kaine (D) authorized Medicaid for the working disabled & a SPAP to supplement Pt. D 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%  But 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 more mentally disabled HCB slots (4,000 are on the waiting list)--and to cut planned hospital & LTC fee raises by $76 million. Kaine dropped a plan for a limited formulary for mental health Rx’s; and the GOP House killed a pilot plan to subsidize insurance for workers under 200% (a private foundation will fund it 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 Basic Health plan (subsidized adult insurance); restored some adult dentistry; covered Pt. D Extra Help co-pays; passed private plan mental health parity; covered assisted living; raised CHIP’s level to 250%; made private plans let children stay covered until 25; and set up another health reform study panel.

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 primary MDs & offer them extra adult mental health care & Rx’s to sign “personal responsibility” contracts (only 7% did; now child and adult mental health coverage is muddled). Budget shortfalls forced him 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 to 300% (now capped by CMS at 250%). The GOP House agreed to raise the CHIP level (71,000 more clients have since 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. See  “..Quick & Easy .. Screening for Medicaid Elig. Under... Pickle Amendment [2008]“ at  http://www.healthlaw.org/library/item.70854

 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 the Gtn. U. Hlth. Pol. Ctr’s state-by-state “Consumer Guide for Getting & Keeping …Insurance”; a state health reform/expansion guide at www.communitycatalyst.org ; the State Health Expansion Resource Center at www.familiesusa.org ; a primer on “How Private Health Coverage Works..” at www.kff.org ; “Understanding the Uninsured..” at www.nihcm.org , finding that ¼ of the uninsured are actually already Medicaid-  or SCHIP- eligible; and “Medicaid, SCHIP & Economic Downturn..” at www.kff.org projecting that 1 million more such persons could enroll in the current recession, costing $3.4 billion ($1.4 billion in state funds).

 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.

 See some useful materials & guides with tips to block bad state Medicaid plan amendments at www.healthlaw.org. To ensure that plan changes/waivers get approved by legislatures & not just Governors & agencies, see http://www.nachc.com/advocacy/Files/state-policy/model520state520legislationh.pdf and http://www.nachc.com/advocacy/Files/ModelStateLegislation-AppropriationsRiderssr031406_RS-.pdf..  

 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.

 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).

 Email  ihoacj@gwumc.edu for charts on state coverage of the working disabled, “pre-disabled” & “ex-disabled”.

 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 CHIP  materials & CMS’ 8/07 & 5/08 letters limiting state income levels over 250% at www.familiesusa.org ; child coverage items at www.georgetown.edu (Hlth Pol Inst pages) for state income levels & waivers to cover parent; and  Rpt.  No. GAO-08-785T at www.GAO.gov saying that Congress can void the CMS limitation rules by joint resolution.

 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”.