“…the thing I find most frustrating about the Medicaid cuts is how cheap it would be to not do this,” writes State Senator Sam Bell. “Because of all the lost federal funds, it would only cost the state $20.2 million to repeal the full $58.7 million of cuts. We don’t have to do this. It would be so easy not do. So let’s not.“
I’m starting my series of problematic parts of the proposed budget with the Medicaid cuts. Because of all of the other harmful Medicaid policies on top of the direct cuts, it’s easy to gloss over the cuts themselves. But there are lots of straight-up cuts. If we let it pass as is, this budget would slash a devastating $58.7 million from Medicaid. And these would be painful cuts.
For each cut, I’ve included a screenshot from the Senate Fiscal Office First Look analysis of the budget with these cuts described in more legalistic terms.
The biggest cut falls on the hospitals, whacking their reimbursement rates by $20.3 million by not making the scheduled COLA. Our hospital system is already under stress. Hospitals are being bought up by out of state corporations, slashing benefits, reducing staffing, and in one case, closing altogether. Yet another hit will push yet more pain.
The next biggest cut is even more painful. It’s $16.8 million, and it comes from imposing and raising co-pays. Medicaid recipients are often very low-income, and even a small co-pay can put care out of reach. Raising them this much will hurt Rhode Islanders in the most desperate circumstances.
Next comes the nursing homes. Conditions in our nursing homes have reached crisis point. It’s not just Park View; nursing homes have been closing down all around the state. Staffing is nowhere near a safe level, and nurses have been calling for a safe staffing ratio with the funding to make it happen. While this budget does earmark a small portion of the nursing Medicaid funds for the workers, it makes an overall cut of $7.5 million by not meeting the scheduled COLA. There is no safe staffing ratio in the budget.
Can we please ask a favor?
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The next cut is sort of a spending increase. The proposal is to spend a quarter million on management consultants who would figure out ways to deny care to very sick people on Medicaid who receive a lot of expensive care. (In budget jargon, very sick people are “high utilizers,” and denying care is “utilization management.”) The idea is that the management consultants will find ways to deny enough care to very sick people that there’s a net cut of $6.1 million.
Then, there’s a $4.6 million cut through the elimination of the Upper Payment Limit payment for outpatient care.
Next comes a $2.5 million cut. It’s an effort to transition neonatal intensive care from a payment model where all services are covered to one where there’s a fixed payment per patient, and healthcare providers are encouraged to reduce the amount of expensive care. Neonatal intensive care is the wrong place for rationing care. It is very expensive to care for babies who are so sick they are at risk of dying. This is not the place where we triage a human life and say that an expensive procedure is just too expensive. A spare no expense approach is the right one here. That’s what anyone would want for their child. Saying that poor people on Medicaid don’t deserve that is cruel.
Finally, there is a deeply worrying cut that, while only $0.87 million, represents an alarming warning sign about what’s going to happen with an enormous portion of the Medicaid budget—the people who are eligible for Medicare as well. The details are complex, and I will get to this in a future post.
Of all these things, the thing I find most frustrating about the Medicaid cuts is how cheap it would be to not do this. Because of all the lost federal funds, it would only cost the state $20.2 million to repeal the full $58.7 million of cuts. We don’t have to do this. It would be so easy not do. So let’s not.
Let’s make this the year when we say no to Medicaid cuts.