Effective June 1st: Medicaid Reduces Eye Care, Prescription and Provider Payments

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By Heather VacLav

Story Created: May 23, 2012 at 5:47 PM CDT

Story Updated: May 23, 2012 at 5:54 PM CDT

About one million people in Alabama receive Medicaid, but as a result of state-mandated budget cuts, many of those patients will see changes in their health care next week.

 

The changes, effective June 1st, will only affect adult services, and are targeting three major areas: prescription drugs, eye care and the way Medicaid reimburses healthcare providers.

 

Governor Robert Bentley issued 10.6% proration to balance Alabama’s General Fund Budget. Medicaid was then forced to reduce its budget of $643 million by about $68 million for the 2012 fiscal year, which ends September 30.

 

Many senior citizens like Watson, are on a fixed income, and say they don’t know what they would do without Medicaid, especially for basic needs like eye glasses. “I just got this pair a week ago, but I’ve been getting them every two years,” said Eddie Watson of Montgomery, a Medicaid patient. Under the new changes, Medicaid will not cover new eyeglasses for people like Watson.

 

Medicaid is also changing its eye exam policies, from once every two years to once every three years. Prescription drugs are also affected. Currently, Medicaid covers four name brand drugs per month with unlimited generic prescriptions, but effective June 1st, Medicaid will only cover patients for one name brand and unlimited generics each month.

 

“It is not going to prevent them from getting the drugs they need,” said Dr. Don Williamson, Alabama’s State Health Officer. “What it will do, is it will challenge and in some cases, creativity to construct a new therapeutic profile for the patients.”

 

Dr. Williamson says patients aren't the only group in the state affected, so are doctors. Medicaid health care providers will be reimbursed 10% less for patient services. According to Dr. Williamson, doctors like pediatricians have higher volumes of Medicaid patients, and they are concerned the cuts will affect their ability to stay in business.

 

“They're going to find themselves having to reevaluate,” Williamson said. “In one case whether they can even stay in Alabama, in another case whether they are going to have to move to an urban center where they can maybe get a more favorable patient mix.”

 

While the proration cuts start up next week, Medicaid could lose even more money come September. The state legislature passed a bill so Alabamians will vote to decide the fate of the General Fund Budget for Fiscal Year 2013. Leaving the fate of Medicaid in voters’ hands is not a risk the agency or many patients want to take.

 

“I think the thing that frightens me, is that we could erase generations of progress very quickly,” Dr. Williamson said.

 

Eddie Watson says for him, Medicaid is a matter of life or death. “I don't believe I could make it, it’s important to me to have Medicaid.”

 

For every $1 Alabama spends on Medicaid, the federal government puts forth another $2. Dr. Williamson says the current $68 million in cuts is more like $210 million in total loss of state and federal dollars.

 

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