{"id":2657,"date":"2011-12-07T07:50:05","date_gmt":"2011-12-07T14:50:05","guid":{"rendered":"http:\/\/stateimpact.npr.org\/idaho\/?p=2657"},"modified":"2013-05-13T15:11:44","modified_gmt":"2013-05-13T21:11:44","slug":"six-months-in-evaluating-the-effects-of-a-medicaid-cut","status":"publish","type":"post","link":"https:\/\/stateimpact.npr.org\/idaho\/2011\/12\/07\/six-months-in-evaluating-the-effects-of-a-medicaid-cut\/","title":{"rendered":"Six Months In, Evaluating The Effects Of A Medicaid Cut"},"content":{"rendered":"

It\u2019s relatively simple to describe the Medicaid cut approved by the Idaho Legislature early this year.\u00a0 State leaders made about $35 million in targeted cuts.\u00a0 That meant fewer federal matching dollars, and a total funding loss of nearly $100 million to the state\u2019s Medicaid program.\u00a0 The economic and personal reverberations are more difficult to tally, but they include job loss and a change in quality of life for some of Idaho\u2019s most vulnerable residents.<\/p>\n

<\/param><\/param><\/embed><\/object>Six Months In, Evaluating The Effects Of A Medicaid Cut<\/a> <\/p>\n

The healthcare sector has been a bright spot in Idaho\u2019s years of economic distress.\u00a0 It\u2019s the state\u2019s fastest growing industry, according to the Idaho Department of Commerce.\u00a0 So it\u2019s worth considering the employment effects of the cut approved last session.\u00a0 Idaho\u2019s former chief economist Mike Ferguson says you can\u2019t take away millions in spending without repercussions.\u00a0 “You know, if you\u2019re taking those dollars out of circulation, there are going to be impacts,” he said.
\n<\/em><\/p>\n

\"\"<\/a>

Molly Messick \/ StateImapact Idaho<\/p>

Katherine Hansen is the Executive Director of Community Partnerships of Idaho, Inc.<\/p><\/div>\n

Ferguson hasn\u2019t done a thorough analysis, but he says it\u2019s fairly simple to arrive at a ballpark estimate of potential job losses, because the greatest cost of the services provided through Medicaid is wages. “If you look at, say, $50,000 dollars per job,” he said, “that means a million dollars is about 20 jobs, so ten million is going to be 200 \u2013 we\u2019re talking maybe 2,000.”<\/p>\n

Of course agencies and hospitals can also shift costs.\u00a0 Nevertheless, Medicaid service providers say last session\u2019s cut has already had an effect.\u00a0 Katherine Hansen is the Executive Director of Community Partnerships of Idaho, a for-profit company that provides services to adults and children with disabilities.\u00a0 It\u2019s one of the largest agencies of its kind in the state.\u00a0 “On the whole, we lost 51 jobs in the last 12 months,” she said.\u00a0 “We had 420 employees last year at this time, and this year we have 370.”<\/p>\n

Most of those cuts were full-time positions.\u00a0 And Hansen says most are due to one particular change.\u00a0 Many adults and children with disabilities receive what\u2019s called developmental therapy.\u00a0 It aims to help with day-to-day skills and allow people to live more independent lives.\u00a0 It\u2019s offered individually or in groups, but a change that went into effect July 1 got rid of separate reimbursement rates.\u00a0 Instead, there\u2019s a new combined rate projected to save $3.6 million in state and federal spending each year.<\/p>\n

Hansen says the rate change is frustrating because developmental therapy is one of many services that was found to be underfunded five years ago. “There was legislation that passed that required the department to work with providers to create a fair and reasonable methodology for rates,” she said.\u00a0 \u201cThe department\u201d is the state Department of Health and Welfare, which administers Idaho\u2019s Medicaid program. “Providers like ourselves gave them all of our financial records to show what it costs to provide the service, and 98 percent of the services were underpaid,” Hansen said.\u00a0 “And the department said, ‘Once we have money, we\u2019ll start paying the proper rates.’\u00a0 At that time, developmental therapy, as a good example, was about 80 percent of what the rate should be.”<\/p>\n

Agencies like Hansen\u2019s take a big hit under the cuts approved last session.\u00a0 State leaders preserved services for low-income children, but changed some services for adults, including people with developmental disabilities and mental illness.\u00a0 In addition, they reduced reimbursement rates.\u00a0 That strikes at a broader swath of health care providers, including hospitals.\u00a0 Idaho Hospital Association president Steve Millard couldn\u2019t be available for an interview, but he did say in an e-mail that the state has placed the “continuing burden” of supporting the Medicaid program “squarely on the shoulders of hospitals, doctors and other providers.\u201d\u00a0 He said that can be a factor in hospitals\u2019 hiring decisions. He also said that continuing to cut funding while Medicaid enrollment goes up isn\u2019t sustainable.<\/p>\n

As for the actual people<\/em> affected by all of this, the greatest impacts appear to be on those with developmental disabilities or mental illness.\u00a0 Christine Pisani is a program specialist with the Idaho Council on Developmental Disabilities.\u00a0 “It\u2019s inhumane to watch what\u2019s happening to people with disabilities in our state,” she said.<\/em><\/p>\n

This summer, Pisani began interviewing Medicaid recipients about how recent cuts are affecting them.\u00a0 None of those she has talked to wanted to participate in a radio interview, but Pisani agreed to share some of their stories.\u00a0 She says service reductions mean one man she\u2019s spoken to, who has cerebral palsy, may no longer receive assistance with basic things like getting out of bed in the morning.\u00a0 And there are other examples.\u00a0 “In June, I interviewed a gentleman who has chronic depression.\u00a0 He was receiving psychosocial rehab services and had those hours cut.”<\/p>\n

Psychosocial rehab, also called PSR, helps recipients maintain good mental health by helping them stay on track with medications, for example.\u00a0 Since 2009, the maximum number of weekly PSR hours has been cut and cut again, from twenty to ten to five and now to four.\u00a0 “So he gets four hours a week, and for the most part, the rest of the time, he was in his apartment,” Pisani said.\u00a0 “Unless he was making it to a counseling appointment or getting groceries, which he was able to get a friend to give him a ride.\u00a0 But that\u2019s probably a limited number of people that were coming into contact with him.”<\/p>\n

Now, Pisani is worried.\u00a0 This man isn\u2019t responding to calls, or following his usual routines.\u00a0 “We\u2019ve recently tried to get in touch with him, and have not been able to get him by phone, and he doesn\u2019t show up in the regular places where he typically used to frequent.\u00a0 So there\u2019s a lot of concern at this point about what\u2019s happened with him.”<\/p>\n

She\u2019s afraid he might be suffering terribly.\u00a0 Pisani says the man has developmental disabilities in addition to mental illness.\u00a0 Not only was he affected by the cut in PSR hours.\u00a0 He also lost services due to an earlier legislative change that forced people with dual-diagnoses to choose which disability to address<\/a> through skill-building.<\/p>\n

\"\"<\/a>

Idaho State Legislature<\/p>

State Representative Carlos Bilbao is a Republican from Emmett.<\/p><\/div>\n

Pisani says that\u2019s not the only dramatic choice recipients have faced.\u00a0 “I know of three individuals<\/p>\n

whose budgets have been cut to the point where they have now moved to a nursing home,” she said.\u00a0 She says these are people in their 30s and 40s.\u00a0 And she says it\u2019s evidence that cuts can drive costs up.<\/p>\n

A number Idaho legislators did not return requests for comment, but Representative Carlos Bilbao, Vice-Chair of the House Health and Welfare Committee, did agree to an interview.\u00a0 He said last session\u2019s cuts were painful.\u00a0 But, he said, revenue projections gave legislators a choice between lowering spending or raising taxes.\u00a0 And he and others were firmly against tax hikes.\u00a0 Bilbao said he believes that reinstating some of the Medicaid funding will be a main focus in the upcoming legislative session \u2013 but that depends on the amount of money available.<\/p>\n","protected":false},"excerpt":{"rendered":"

It\u2019s relatively simple to describe the Medicaid cut approved by the Idaho Legislature early this year.\u00a0 State leaders made about $35 million in targeted cuts.\u00a0 That meant fewer federal matching dollars, and a total funding loss of nearly $100 million to the state\u2019s Medicaid program.\u00a0 The economic and personal reverberations are more difficult to tally, […]<\/p>\n","protected":false},"author":46,"featured_media":2667,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[15],"tags":[65,46,74],"acf":[],"_links":{"self":[{"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/posts\/2657"}],"collection":[{"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/users\/46"}],"replies":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/comments?post=2657"}],"version-history":[{"count":1,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/posts\/2657\/revisions"}],"predecessor-version":[{"id":2687,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/posts\/2657\/revisions\/2687"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/media\/2667"}],"wp:attachment":[{"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/media?parent=2657"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/categories?post=2657"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/idaho\/wp-json\/wp\/v2\/tags?post=2657"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}