Site Logo

Hearings set on Medicaid plan

Published 9:00 pm Monday, May 27, 2002

Associated Press

OLYMPIA — How much should poor people pay for health care?

That question lies at the heart of a state proposal to impose premiums, co-payments and enrollment caps on some Medicaid clients and services.

State officials say people need to take responsibility for at least part of their health care costs if Medicaid is going to survive. But some people — including Washington’s entire congressional delegation — worry the plan would hurt children by making it harder for poor families to get health care.

Now it’s your turn. The Department of Social and Health Services is holding public meetings around the state where people can learn about the proposed Medicaid changes and speak their mind.

Medicaid provides health care to 900,000 poor people in Washington. The $2 billion yearly cost, split by state and federal government, eats up about 10 percent of the state budget. During the last decade, Washington led the nation in expanding Medicaid to cover more people. Now one in three Washington children get their health care through Medicaid.

But as health care costs grow rapidly, the state is struggling to afford Medicaid.

That’s why the state is asking the federal government for permission to charge some Medicaid patients co-pays and premiums, and to cap enrollment in some programs. State officials say the plan would allow them to avoid broader and more destructive cuts.

State officials submitted an intentionally vague "Medicaid reform" plan last December, hoping the federal government would give them broad powers to tinker with Medicaid benefits. But the Centers for Medicaid and Medicare, the federal agency in charge of the program, kicked the proposal back to Washington State and asked for more specifics and more public comment.

In July, after the public hearings, the state will resubmit a more specific plan.

Here are some details of the proposal:

  • Co-payments: Clients who want more expensive, name-brand drugs would have to pay about $5 per prescription if there’s an equivalent, less costly generic available. Also, clients who go to emergency rooms for non-emergencies would have to pay about $10.

  • Premiums: Some clients who make more than the federal poverty level ($18,100 for a family of four) would have to pay annual premiums. The state Department of Social and Health Services hasn’t yet determined how much the premiums would be, but Porter says on average, they wouldn’t cost more than 5 percent of a family’s income. If a family of four made twice the poverty level, that would be $1,810.

  • Enrollment caps: The way it works now is that the Legislature budgets money for Medicaid according to forecasts of how many people will need services. During rough economic times, the need — and the expense — often surges above the forecasted number. So the state goes ahead and serves those people, then presents the Legislature with the bill after the fact. This proposal would trigger an enrollment freeze when enrollment exceeds the budgeted forecast. New applicants, except for the most needy, would have to wait until the Legislature lifts the freeze by supplying more money.

    The state Department of Social and Health Services has scheduled public meetings across the state to discuss the proposed changes to Medicaid, including co-payments and enrollment caps on some services. All the meetings will be held from 6-9 p.m.

  • May 30, Bellingham, Garden Street Family Center

  • June 6, Seattle/Shoreline, Shoreline Community College, Room 1102

    For more information on the Medicaid waiver meetings, call 800-562-3022.

    For more information or to comment on the Medicaid proposal, visit the Medicaid waiver Web page at http://maa.dshs.wa.gov/medwaiver

    Copyright ©2002 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

    • You Might Like