Monday, May 2, 2011

State By State Medicaid Watch

Important Information To Notice 
As you look at each State, notice the SSI rates. Now, to all of those that say people dependent on entitlements are living the high life need to seriously ask themselves.... could they live on $674 a month? As I mentioned in earlier posts, once you are dependent on these programs it is extremely difficult to claw your way out. People are caught in a situation where they cannot do anything to screw up those benefits, if they do, they will lose everything. There are programs like the DVR which provides education and job training but it's a three ring circus to actually get the help that's there. This entire system is so confusing and time consuming! Sometimes it's a full time job dealing with all of the red tape, time that could be spent earning income.

Please take the time to read this report and resource guide at the end of the review. Hopefully this information will answer questions and raise new ones that will demand answers.

Email From Medicaid Watch
Attached is the May 1, 2011 edition of the MEDICAID WATCH. Noteable and recent state developments and proposals that expand access and eligibility appear in blue, while noteworthy and recent state developments and proposals that reduce access and eligibility are printed in red. The last two pages contain a regularly-updated and current listing of sources and resources on state-level health coverage, with the most relevant news, facts and documents highlighted in yellow.
What's still well-worth looking over are studies cited on pages 12 and 13 successfully refuting reform opponents' misinformation that the reforms will cost states huge sums of money. In fact these studies show that states will actually get billions more in US funds. Moreover, we've prepared and have continually updated papers for advocates to share with---and then insist that state health officials facing serious budget shortages wioll actually implement---savings methods for state Medicaid and ADAP programs that avoid cuts in eligibility, benefits and already-too-low provider rates (rather than resort to the easier, stroke-of-a-pen eligibility, benefits or reimbursement cuts they've traditionally relied on. 

The MEDICAID WATCH doesn't cover only state-level Medicaid eligibility and access news; it also reports on other state health assistance programs, including:
* the State Children's Health Insurance Programs (SCHIP);
*states' own non-federally-funded medical assistance programs;
*State Pharmacy Assistance Programs (SPAPs);
*State AIDS Drug Assistance Programs (ADAPs); 
*state-subsidized or  -sponsored health insurance programs for limited income persons;
*state-subsidized high risk health insurance pools (including premium discounts given by some risk pools 
    to those with incomes under state-set levels); and 
*safety-net hospitals offering free or discounted care to the indigent.
For each state, we note, as percentages of the 2011 annual Federal Poverty Level (FPL), the most recently-tabulated income eligibility levels for Medicaid for the aged and disabled; for parents; and for childless, non-disabled adults (if they get Medicaid through an eligibility expansion, a waiver or via some other public Medicaid-like state program). We also note eligibility levels for SCHIP; ADAPs; SPAPs; state-subsidized or -sponsored health insurance; states' Medicare Savings Program (MSP) income and asset eligibility liberalizations that exceed the federal minimums; and income eligibility levels for any pre-health reform state-only-funded risk pools' low income premium discount programs.
Please share this with your colleagues and affiliates at the state and local level. We welcome your comments, news items and corrections; we're very eager to share our Medicaid and ADAP savings papers with you at your request; email me at .
Thomas P. McCormack
Member, Health and Medicaid Task Forces
Consortium for Citizens with Disabilities (CCD)
Public Benefits Policy Consultant
Community Access National Network (TIICANN)
Washington, DC
(202) 479-2543
State Medicaid and Health Cuts & Expansions
May 1, 2011;  See pp 12-13 on updated sources & resources on state health programs
                                     National Snapshot Summary
States made/are planning cuts or expansions in AK, AL, AZ, CA, CO, CT, DC, FL, GA, HI, ID, IL, IA, KS, KY, LA, ME, MD, MA, MI, MS, MN, MT, NV, NJ, NM, NY, NC, OH, OK, OR, RI, PA, SC, TN, TX, UT, VT, VA, WA, WI  & WY
Almost all states already pay far-too-low fees to MDs, DDSs, hospitals & nursing homes and now almost all states are lowering those rates even more.
Some states have monthly numerical limits on Medicaid Rx’s—with very strict & low monthly caps in AL, AR, GA, KY, LA, MS, OK, SC, TN, TX & WV..
More & more states deny adults non-emergency dental care & even dentures.
Nearly 7,900 are on ADAP waiting lists in AR, FL, GA, ID, LA,  MT, NC, OH, SC, UT, VA & WY; other states are starting waiting lists & making other cuts too.
State Pharm. Asst. Progs. (SPAPs) in AK, IN, NY, PA, SC & WI exclude the disabled; and HI, IL, MD, MO, MT & RI give the disabled lesser coverage
15 of 35 pre-health reform risk pools do not discount premiums for the poor
Alabama--has no spend down, an aged/disabled level of $674 (the SSI rate), a parent level of 11%/ 24% if wkg (’11) & an ADAP level of 250%; covers 12 MD visits & hosp days/yr & only 5 brand  Rx’s/mo but has no MSP asset tests Medicaid’s 2011 deficit is $64 mil-lion The old legislature (D) cut HIV care $2 million but overrode a veto to raise CHIP’s 200% level to 300%. The risk pool had once planned low income premium discount but has no Medicare supplement. There are 2,500 on the HCB waiver waiting list. Gov Bent-ley (R) & the legislature (both Houses are now R) face a $700 million Medicaid shortfall; and may have been forced to start an ADAP waiting list as of 4/1/11 & cut its formulary.

Alaska---this Title XVI state has no spend down; an aged/disabled level of $1,036/mo (its SSI/SSP rate), a parent level of 77/81% if wkg (‘11), a 300% ADAP level, a risk pool with a Medicare supplement but no low income premium discount & a token SPAP for those under 175% that excludes the disabled. In spite of a $60 million 2011 deficit, Gov. Parnell (R) & the legislature (R House; tied Senate) raised the 175% CHIP level to 200%. While  he rejected US grants to plan an Exchange & increase reviews of health premium raises, he quite surprisingly requested a $160 million budget increase---one-third for Medicaid!
                                              Arizona--covers parents & childless--even non-disabled--adults under 100%/106% wkg.                         
                                                  The CHIP level is 200% & ADAP’s is 300%. The legislature (R) killed a program to cover                                                                                                
                                                  the disabled during the 2 yr Medicare wait, cut MD fees & personal care funds but gave up                      
                                                  up CHIP. With a budget short billions, Gov Brewer (R) cut ADAP’s formulary, mental                                        
                                                  health funds & home  care, ended hospice & non-emergency transport & kept a CHIP                                              
                                                  freeze that’s cut enrollment by over 10,000, with a waiting list of 40,000. She started new -                                             
                                                  & raised existing co-pays; will drop the spend down by July 1 & ended coverage of  physi-
cals, podiatry, most dentistry, dentures, transplants (she’s now relenting), medical equip., insulin pumps, hearing aids, co- chlear implants & computerized lower limb prostheses. HHS Sec Sibelius said she can’t legally stop the soon-expiring waiver that covers 280,000 childless, non-disabled adults (even if mandated by a state voter referendum). Brewer now says she’ll let the coverage lapse by attrition, charge the obese & smokers $50 fees and just proposed a lower parent level

Arkansas—has an aged/disabled level of $674 (the SSI rate), a parent level of 13%/17% wkg (’11), a monthly numerical Rx limit & an insurance subsidy for workers below 200% in participating small firms. Gov. Beebe & the legislature (both D) covered adult dentistry & passed an unfunded bill to raise CHIP’s 200% level to 250%. The risk pool bans Medicare patients but plans to fund low income premium discounts. Beebe may cut the number of covered MD visits & Rx’s; did cut ADAP’s formulary & its income level from 500 to 200% (dropping 99 clients in 9/09) & now has a waiting list of 63. He needs $174 million more for the fiscal 2012 Medicaid budget just to maintain eligibility, services & provider payments ---and proposed imposing the DRG payment system further on hospitals & even for MD services as an economy measure

California-- The state covers the aged/disabled under 100% (with a $230, not just a $20, disregard), parents below 200% (’11) & prostate cancer patients under 200%. ADAP’s level is 400% & CHIP’s is 250%. With a $19 billion deficit, ex-Gov. Schwarzenegger (R) & the legislature (D) raised premiums; capped child dental care at $1,500-$1,800/yr; cut podia-try & psychiatric benefits; denied non-emergency care to legal aliens & cut provider fees. A $2.75 billion cut dropped  3 million adults. He denied ADAP to county jail inmates & proposed a lower parent level, ending  home health care & pers-onal aides for the disabled & cutting low income clinic funds. Gov Brown (D) will sign bills reducing “non-life-saving” Rx’s to 6 /mo, MD visits to 7/yr ; charging $50 ER, $5 MD & $100 hospital admission co-pays; and cutting MD fees 10% A $300 million 2011 LA Co. Health Dept. shortfall may cut patients served by 33% to 50%. Courts barred dropping adult podiatry, chiropractic & dental care, at least until CMS agrees. The legislature cut in-home care and DD & mental health funds. Brown added $77 million to ADAP, is starting a state Health Exchange & plans to add county medical assistance patients (childless, non-disabled legally resident adults) to US-matched Medicaid, as allowed by the US health reform law

Colorado---has no spend down. The level for those over 60 is $699 (their SSI+ SSP rate), but it’s only $674/mo (the SSI-only rate) for younger disabled. ADAP ‘s level is 400%. The risk pool has low income premium discounts for those below $50,000 & Medicare supplements. Ex-Gov Ritter (D) began a formulary, made health plans cover PTSD, anorexia, sub-stance abuse & colorectal screening and cut ADAP’s formulary. Medicaid’s caseload is up 200,00 since 2001, but he & the old legislature (D) passed a hospital tax to raise $600 million for Medicaid, CHIP & the state indigent health program; boost hospital rates & uncompensated care funds; and cover 100,000 more persons by raising all adult levels to 100% (it already covers parents & by 2012 will also cover childless, non- disabled adults) with newly-offered US health reform matching; applied the mini-COBRA law to small firms; raised CHIP’s level from 205 to 250% & widened its psychiatric care; planned to offer Medicaid to the working disabled starting 7/1/11, began a SPAP for HIV clients; covered legal al-iens; set a 300% level for nursing home & HCB waivers (with liberal HCB, personal aide features,& with some patient autonomy. Some parents & advocates for disabled children say the state’s 300% FOA level is too low to reach enough such children; that their Medicaid premiums are too high; and that the state still rations how many cases can be covered. The state let HMOs sell cheap policies to the uninsured--but cut funds for DD & disabled clients’ employment, transport & personal aide pay and may start an ADAP waiting list. Gov Hickenlooper & the Senate (both D), who campaigned for health expansion, plan instead to cut services $13 million, with likely help from a bare 1-vote  new GOP House majority
Connecticut—is a 209(b) state with 2-zone aged/disabled levels ($786.22 & $894.61, its SSI/SSP rates for those with at least $400/mo shelter costs, and a $278 disregard). Its parent level is 185%/191% wkg {’11); ADAP’s  is 400%; CHIP’s is 300%; and its risk pool has a low income premium discount for those under 200% & a Medicare supplement. Ex-Gov. Rell (R) ended SPAP coverage of Pt D non-formulary Rx’s (but still covers Pt D-excluded Rx’s); yet there’s no MSP as-set test & SPAP income levels are $25,100 for 1; $33,800 for 2). She limited adult chiropractor, naturopath, psychologist  and occupational, physical & speech therapy coverage to clinics; but extended hospice care to all Medicaid patients. The legislature (D) covered the working disabled. Rell wanted to force patients back into HMOs to fund the skimpy, subsidiz-ed “Charter Oak” insurance plan she set up for parents under 306% & other adults under 310%. With premiums up 72% since 1/10, it has big co-pays, limited psychiatric care, low caps on Rx’s, medical equipment & total yearly costs and a $1 million life-time cap--and may have to close enrollment. CMS provides US matching to give Medicaid to childless non-disabled adults under 56% who were eligible for state Gen Med Asst (even keeping its $150/mo  earnings dis-regard), extended COBRA to 30 mos, and raised QMB’s income level to 207%+, SLMB’s to 227%+ & QI’s to 242%+ (giving most SPAP clients full Pt D Extra Help too). 2011’s deficit is $263 million. Gov Malloy (D) is considering merging Medicaid & public worker health plans, is moving 2,200 nursing home patients into home or HCB  care & will cancel CHIP & Charter Oak managed care contracts, but cut adult dental coverage & low income clinic funding by $3.8 million
Delaware---has no spend down; covers parents under 100%/120% if wkg & all other adults under 100%/110% if wkg; the ADAP level is 500% and those for CHIP & the SPAP are 200%. Gov. Markell & the legislature (both D) operate a state-funded cancer assistance program for those under 650% & state-funded medical assistance (more limited than Medicaid) for others under 200%, covered the working disabled and may let over-income children buy into CHIP.

District of Columbia---has parent levels of 200%/207% if wkg, 100% for aged & disabled, 300% for CHIP & 400% for ADAP. DC’s own non-federal medical assistance covers others under 200%/211% if wkg. Ex-Mayor Fenty & the Council (both D) covered adult dentistry; raised the QMB level to 300%  & dropped its asset test (thus giving many DC Medicare patients full Pt D Extra Help). But he proposed replacing public mental health clinic care with private contractor services & cutting funds for low income clinics, revoked DC’s just-raised MD fees for dual eligibles and cut home care & funding for the disabled’s personal aides. DC Medicaid was extended in 12/10 to childless, non-disabled legal residents under 200% who were on non-federal medical assistance, using new US health reform matching. DC is keeping the safety net, debt-ridden United Med Ctr (formerly Greater SE Hosp) open after acquiring it at public auction. CMS says DC--facing a $600 million 2 yr deficit—still owes $58 million for over-claimed 2004-05 matching, which Mayor Gray (D) contests

Florida---The legislature (R) got a waiver to move patients (a court order does let them opt out) into contract managed care; but it has so far done so in only 5 counties & its request to extend the waiver is now being blocked by CMS. Yet the legislature & Gov. Scott (both R) still want to expand managed care, cut MD fees & slash Medicaid costs by $1.8 billion (one GOP leader’s bill denies spend down eligibility for I/P hospital care & to anyone who isn’t a non-pregnant adult). The under-funded, often-closed pre-health reform, state risk pool has a Medicare supplement but no low income premium discount. The state cut the aged & disabled level from 88% to SSI’s $674/mo rate, except for those in HCB waivers or in Medicare’s 2 yr disab-led waiting period. The parent level is 20%/59% wkg (‘11).. The state covers dentures (but little other adult dentistry) & hearing aids. Ex-Gov Crist (I) dropped coverage of Zyprexa & Invesa Sustena, made private plans cover autism care, gut-ted the insurance minimum benefits law& fostered cheap policies for the uninsured (see  HYPERLINK "" ;start-up is delayed to late 2011 since its policies may not meet US health reform insur-ance rules without a waiver). Blue Cross & a local health dept sponsor cheap ($105/mo for 1 under 250%), lean “Miami-Dade Blue” policies with no brand name Rx benefit. Crist dropped hospice & cut dialysis, mental health & substance ab-use funds & MD fees. 19,000 are on HCB & home care waiting lists, so to settle a suit Crist agreed to spend $27 million more on HCB waivers. Advocates say that isn’t enough with such a backlog & they’ve filed a class action suit against the state. Crist raised cigarette taxes $1 to yield $1 billion (much for Medicaid), vetoed nursing home & DD care fee cuts; and made insurers sell Medigap policies almost as fairly to the disabled as to the aged. Miami’s Jackson Mem Hosp faces ris-ing deficits, is closing 2 O/P clinics & 2 transplant units; and ending dialysis for 175 indigents (many of them illegal ali-ens). ADAP cut its formulary & has a waiting list of 3,705 (even though 5,403 were transferred to the private Wellvista charity HIV drug program) to which 1,000  more could be added.  The HIV premium assistance income level is 400% & neither it nor ADAP have asset tests). ADAP is short $1.5 million even after it got $1 million from other HIV accounts; the premium assistance program has its own waiting list of over 260; and the ADAP level was cut to 200%. Funding cuts forced Jacksonville to close 3 public low income clinics.  Scott ordered a 15% cut in funds for DD facilities & their staffs.

Georgia---Its aged/disabled level is $674/mo (the SSI rate), its parent level is 28%/50% if wkg (‘11), ADAP’s is 300% & CHIP’s is 235%. It has a monthly numerical cap on Rx’s; dropped CHIP dental surgery coverage & raised its premiums;
ended routine adult dental & artificial limb benefits & nursing home spend downs; and narrowed Katie Beckett waiver ad-mission rules. Ex-Gov Perdue & the legislature (both R) herded patients into HMOs, but allow opt outs. Atlanta’s Grady Hosp, with a $6 million deficit from indigent care costs, closed its dialysis center (but arranged continued care for indigent illegal alien patients) & 3 of its 9 O/P clinics and cut its free care level to 125 from 250%. With 2011’s $506 million Med-icaid shortfall, Perdue wouldn’t  raise provider fees & cut ADAP $1.2 million. He’d hoped to get a hospital bed tax (with proceeds used to attract more matching), but MD & DDS fees will be cut anyway; sought more insurance taxes & fines to pay health costs, closed a mental hospital building, cut pregnancy & infant care funds; imposed ADAP medical criteria (it’s waiting list is 1,384) & proposed privatizing some mental health care. Gov Deal (R) wants even more cuts (i.e., end-ing adult podiatry, vision & emergency dentistry) but the House budget would retain them. Yet he still wants to raise adult O/P services co-pays 15%. their I/P co-pays by a whopping 400% & even impose co-pays on children for the first time.

Hawaii—this 209(b) state gives limited Medicaid benefits to all adults below 200% (even the  childless & non-disabled), but only parents & the aged & disabled under 100% get full Medicaid. Its ADAP level is 400%. & it covers the working disabled. Ex-Gov. Lingle (R) and the legislature (D) raised CHIP’s level to 300%, ended its premiums and let richer chil-dren buy into it at full price. With an $86 million 2011 shortfall, Lingle began moving 37,000 aged & disabled into man-aged care, ended non-emergency adult dentistry & planned benefit cuts for non-pregnant & non-disabled adults. Gov Ab-ercrombie (D) favors health expansion, but had to seek a $25 million Medicaid cut for FY ‘12 & $50 million for FY ‘13

Idaho--is a Title XVI state, with no spend down, an aged/disabled level of $727 (the SSI/SSP rate), a parent level of 21%/ 39% if wkg (‘11) & a 200% ADAP level. The legislature (R) raised the CHIP level from 150 to 185%; funds a pilot plan for small firm workers under 185%, covered the wkg disabled & sorted clients into 3 groups: Parents & children; disabled & chronic cases; and the aged. Each may get differing benefits or co-pays but also more preventive care. Gov. Otter (R) charges 4% of income premiums to Katie Becket cases. The deficit is $86 million+ & he may charge all disabled children extra premiums; and cut hosp, MD, rehab facility & DD agency fees (which a court then voided temporarily) and occu & speech therapy & autism care funds; and did cap ADAP enrollment (with a waiting list of 11). He & the legislature are exacting Medicaid cuts of $34 million in 2012: more & higher co-pays; lower Rx fees; and audiology, vision, podiatry & mental health cuts; reducing adult dental benefits to extractions & pain emergencies; moving more patients into managed care; and imposing a $7.5 million “assessment” on hospitals & nursing homes. Legislators say they’ll closely compare costs with clinical results. The House earlier voted to end an adult cystic fibrosis program & non-emergency transport.

Illinois--this 209(b) state’s aged/disabled level is 100% (with a $25, not just a $20, disregard).Its main SPAP excludes the disabled not yet on Medicare, who get only a very limited formulary from a 2nd SPAP. Both SPAPs’ income levels are;  $27,600 for 1, $36,635 for 2, etc. The legislature (D) raised the parent level to 185%, accepted a court order to raise pedia-tric fees (yet other fees are too low & paid very late, with a $9-$10 billion unpaid claims backlog; for which Gov. Quinn [D] proposes to borrow $2 billion---which, with US matching, would fund a start in paying it down), raised CHIP’s level 200 to 300%. The often-closed risk pool has a Medicare supplement but no low income premium discount (yet the new, separate US health reform-funded state risk pool’s premiums are affordable for those under age 40, and can be co-ordina-ted with ADAP and/or Pt D). The state raised the wkg disabled level to 350% & required that Medigap policies be sold as fairly to the disabled as to the aged. The U of Chicago Med Ctr closed its women’s & dental clinics & the U of IL at Chi-cago closed a clinic too. The state gave $640 million to safety net hospitals, made hospitals give the uninsured dis-counts & imposed an “assessment” on them to attract $450 million more in US matching. With a $13+ billion deficit, the legisla-ture gave Quinn authority to cut the budget ($500 million in human services cuts, even in community mental health, are likely), and they raised the 3% state income tax by 2.25%); require better income verification by applicants; force more patients into “medical homes” with managed care, cut hospital & nursing home rates 6%; and deny CHIP to children with income over 300%. He hopes to save $400 million more with case management for the aged & disabled (38,000 of whom are already on HCB waiting lists) & gave ADAP an increase to serve 4,500 more clients, but a possible $3 million ADAP cut may mean lowering its income level from 500 to 350%. The budget also calls for abolishing one or both SPAPs.

Indiana---this 209(b) state’s SPAP for those under 150% excludes the disabled & has a much-stricter-than-SSI “209(b)” Medicaid disability rule (one must be fatally or incurably ill). The aged/disabled level is $674 (the SSI rate) & the regular Medicaid parent level is 19%/25% wkg (‘11). Gov. Daniels & the legislature (then & now again all-R) raised CHIP premiums The  risk pool has a Medicare supplement & a low income premium discount. The ACLU sued to void a once-each-6-yrs denture replacement & re-lining limit (and the legislature is now considering a once-every-5-years eyeglasses replacement limit). ADAP (with a 300% level) may have to start a waiting list & 21,000 DD clients are already on a HCB waiver waiting list, but Daniels raised the CHIP level from 200 to 300%. A waiver subsidizes coverage for parents below 200% & even has 42,000 slots for the childless, non-disabled under 65 (with 52,000 more on a waiting list when he closed enrollment). He opposed the US health reform bill, but now seeks to extend the waiver & then use newly-available US health reform matching to cover all non-aged adults under 133% by--or even before--2014 (but only if HSAs are allowed). Waiver coverage uses HMOs; has few co-pays & no dental, vision or maternity care; patients must put 2%-5% of income into HSAs,  pay almost unafordable premiums & meet $1100/yr in cost-sharing; it has $300,000/yr & $1 million/life time coverage caps. Daniels plans to cut hospital, nursing home & other provider fees 5%. The state Supreme Ct  rejected a suit to make the state consider more possible impairments in Medicaid disability determinations. Medicaid budget cuts will end or limit adult dental, vision, chiropractic & podiatry coverage and Daniels plans to cut the mental health Rx formulary

Iowa--A waiver covers both I/P & O/P care and Rx’s—at first, it could only be at 2 safety net hospitals in Des Moines & Iowa City---for non-Medicare adults (even if childless & non-disabled) under 200%/250% if wkg. But the state later got CMS approval to expand the waiver to let patients get care at any low income clinic in the state and (at least) emergency care at any hospital in Iowa. The aged/disabled level is $674/mo (the SSI rate), the parent level is 28%/ 83% if working (‘11) & ADAP’s  is 200%. The risk pool has a Medicare supplement but no low income premium discount. Medicaid faces a $600 million shortfall. Ex-Gov. Culver & the old legislature (both D) covered disabled children under 300% via the FOA, raised the CHIP level from 200 to 300% & let children without dental coverage buy into CHIP dental benefits. The hospitals are proposing a plan to tax themselves $40 million to attract added US matching funds to raise their rates & fund other rising Medicaid costs. ADAP program costs were capped on 9/15 & there had even briefly been a waiting list. Gov Branstad & the new House majority (both R) intend to make Medicaid cuts (such as ending chiropractic coverage, raising co-pays & requiring pre-authorization for more types of care), but the state Senate is still Democratic

Kansas---this Title XVI state has an aged/disabled level of $674/mo (the SSI rate), a parent level of 26%/32% wkg (‘11), a 200% CHIP level & a 300% ADAP level. Its GOP legislature, covered the wkg disabled, offered state mini-COBRA rights, raised CHIP’s level to 250%; and worked through a long backlog of 12,000 applications. There are 5,700 on wait-ing lists for services for phys disabled & DD clients, yet it cut home care fun-ding for the aged & disabled; put 6,000 more on waiting lists for HCB & home care; cut MD fees & disabled clients’ care-givers’ pay, ended welfare for 1,500 awaiting SSA disability awards; denied dental care to poor women; raised CHIP premiums to $20/mo; and froze admissions to 3 already-full mental hospitals. With a $41 million 2011 human services shortfall, ex- Gov. Parkinson (D) sought to have case managers oversee psychiatric Rx therapy. The state may require more pre-authorizations, co-pays for “unnecessary” ER visits & end state DD facility admissions. Gov. Brownback (R) wants even more health cuts: He ordered Aging Dept employee costs slashed 25%, cut mental health funds $25 million, ended support for community mental health centers, proposed ending mental health services for 850 families with emotionally ill children & told his Lt. Gov. to make Medic-aid cuts of $200 to $400 million yearly by 2013 (probably by forcing the aged & disabled into cheaper managed care).
Kentucky--- has an aged/disabled level of $674/mo (the SSI rate), a parent level of 36%/62% if working (‘11), a 200% CHIP level & a 300% ADAP level. The legislature (R Sen.; D House) dropped tough, yet unworkable, nursing home & HCB medical admission rules; capped Rx’s at 4/mo, limited occu, phys & speech therapy, x-rays & MRIs; raised co-pays; and divided Medicaid’s patients into 4 groups that can get different benefits: healthy adults; children; aged & disabled; and MR & DD patients. Gov. Beshear (D) faces an impending Medicaid/CHIP shortfall of up to $500 million. He said he’d save $108 million in 2011 with more efficiencies & an anti-smoking benefit. His Medicaid cost control committee offered few new solutions. He enrolled 22,000 more children in CHIP & dropped its $20/mo premium. By 9/10 ADAP was able to cover the 227 clients from its waiting list using other funds & making economies, but co-pays & formulary cuts remain in place. After the Senate (R) got the House (D) to join it to reject Beshear’s plan to prevent cuts by pre-spen-ding $167 million this year of the next biennial budget’s Medicaid funds--and instead fund the current shortfall with cuts to education & other state programs---he line-item vetoed their bill (and an over-ride attempt failed). This now lets him unilaterally implement his own Medicaid budgeting plan---centering on much more use of managed care to save money.

Louisiana---has an aged/disabled level of $674/mo (the SSI rate), a parent level of 11%/25% wkg (‘11) & a 300% ADAP level. The legislature (newly R-House; nominally D-Sen) voted to raise the CHIP 250% level to 300% but can’t afford to. Gov Jindal (R) covered the wkg disabled & got CMS to agree to a state refund of only $266 million for past overpayments When a $30 million /yr US primary clinic grant wasn’t renewed, he found other money to fund it; and CMS even let him spend $97.3 million in US Medicaid hospital funds on primary care clinics. He plans to save $268 million by cutting cov-ered Rx’s from 8 to 5 mo (unless more are “medically justified”); & MD & hospital rates and privatizing community serv-0ices & HCB waiver care for the aged, CMI, DD & phys disabled at lower rates. Jindal delayed & may drop plans to put patients into capitated PPOs & HMOs. US matching falls $700 million in 2011, 2012’s deficit is $1.5 billion & he plans a $50 million 2012 cut for Medicaid (including a 20% fee cut for State Univ Hospitals). Yet he somehow got a federal com-mitment for $400 million more for health care and FEMA will pay $478 million to rebuild the N. O. Charity Hosp & the state will add $300 million. It also must find $70-$100 million/yr more for operating costs, while Jindal wants a $62 mil-lion cut for LSU’s Hospitals (even though the state already lacks enough funds to run 4 to 6 LSU & Charity Hospitals as it is). ADAP’s $11.7 million deficit meant shifting $2 million of other HIV funds to it--but there’s still a waiting list of 685.
Maine—The state has these income levels: subsidized insurance, 300% (up to $8 million more in premium subsidies were only recently offered even to part-timers, but Gov. LePage [R] now proposes to lower the 300% level enough to drop up to 14,000 patients); the aged & disabled, 100% (with a $75, not just a $20, disregard for both Medicaid & the MSPs); childless, non-disabled adults, 100% (via a waiver that’s now taking up to 2,000 new patients); parents, 200% &206%  if wkg; ADAP, 500%; CHIP, 200%; the SPAP, $1,604/mo for 1 & $2,159/ mo for 2; and 250% for an O/P-only waiver care for HIV+ (even “pre-disabled”) patients. There’s no risk pool. Adults get dentures but little other dental care. There are no MSP asset tests & QMB’s income level is 150%, SLMB’s, 170% & QI’s, 185%. With a $100 million 2011 deficit, the state raised cost-sharing for those over 150%, cut podiatry care & provider fees and  may have to start an ADAP waiting list .Ignoring a just-written model state health reform plan,  LePage & the new legislature (both Houses are now R) were expected to make big health cuts, but instead joined Democrats to pay hospitals $70 million in past-due bills (but then a re-audit of billing records later showed that, in fact, the hospitals had actually been overpaid  by that same amount) and to add $73 million more to the coming year’s Medicaid budget (for which even more may now be needed because CMS In-spector General auditors now suspect that the state actually over-claimed $150 million in US matching during past years).

Maryland---has an aged/disabled level of only $674/mo (the SSI rate), a 300% CHIP level & a 500% ADAP level. An appeals court upheld an AARP/Legal Aid suit to widen the state’s too-strict nursing home, HCB waiver & at-home care medical qualification & appeal rules. A waiver merged the main SPAP & a state low income O/P clinic program into one O/P-only primary clinic care & Rx program for any non-Medicare adults (even if childless & non-disabled) under 116% (128% for the latter if wkg). A state-sponsored, Blue Cross-run 2nd SPAP (with a 300% level) covers some Pt D donut hole & premium costs, but seems to exclude the disabled. A child’s untreated tooth infection killed him, so the state dental school & a county started 2 indigent child dental clinics. The risk pool has low income premium discounts for those under 200%, but no Medicare supplement. Gov O’Malley & the legislature (both D) covered the wkg disabled, raised the parent level to 116% for full Medicaid & subsidize insurance for some low paid small firm workers. He cut Medicaid $82+ mil-lion, including nursing home, home health aide, private RN & HMO fees & slashed hospital rates to 80% of private plans’ A $389 million 2011 deficit at first forced him to delay a 2nd expansion of full Medicaid to childless, non-disabled adults under 116% --but he later said he’ll now do so with newly-available US health reform matching  He again cut provider, HMO, HCB programs & personal aide fees for the disabled & plans more cuts-- even closing a mental hospital. He & the nursing homes hope to more than make up a fee cut with later rate increases funded by a 2% tax they’ll pay that will at-tract more US matching. With a $1.2 billion 2012 deficit, he’s considering a $150-$264 million hospital “assessment” to attract even more matching with which to raise their rates & meet other Medicaid costs. He’s raising child dental fees, car-ving child dentistry out of HMO contracts for direct state managing & made hospitals give free care to those under 150%

Massachusetts---Ex-Gov. Romney (R) & the legislature (D) expanded Medicaid; required everyone to have insurance; subsidized it for those under 300%; boosted the CHIP level from 200 to 400%; raised the parent & childless disabled Medicaid levels to 133% but kept the childless aged level at only 100%. The ADAP level is 488% & the SPAP’s is 188% (but up to 500% for Pt D patients). Gov. Patrick (D), with a $2.5 billion 2012 deficit, raised subsidized insurance, Medi-caid & SPAP cost-sharing; proposed freezing MD & hospital fees; cut funds for substance abuse, tobacco cessation, school RNs & birth control; restricted legal aliens to limited I/P hospital care & a contract PPO network (which some say has too few providers); and proposed confining adult denture & root canal services to community health centers; raising MD & Rx co-pays (even for generics); requiring prior approval of costly psychiatric Rx’s; ending personal aide care for those getting it under 15 hrs/wk; cutting hospital fees & covered inpatient days to 20; and requiring college students to be insured. He seeks $331 million in US funds to prop up 7 safety net hospitals; and Cambridge Hosp,,Boston Med Ctr,  St. Elizabeth & Carney hospitals face shortfalls. The legislature is considering forcing aged dual eligibles into HMOs. To better control costs, Patrick is exploring a gradual shift to Accountable Care Organizations (ACOs) that pay for wellness & treatment results instead of the traditional fee-for-service basis that’s now driving costs above sustainability; he also ordered a 3% cut in the mental health budget, including $16.4 million for facilities, closing 160 mental hospital beds.

Michigan---has a 100% aged/disabled level a parent level of 37%/64% wkg (‘11), a 200% CHIP level & a 450% ADAP level. It ended adult hearing aid & chiropractic coverage & briefly closed--but then ex-Gov. Gran-holm (D) later re-open-ed --its O/P care-only waiver for childless, non-disabled adults under 35%/45% wkg. The legislature raised co-pays but raised child wellness, dental & adult preventive fees. The Lansing, Muskegon, Detroit & Flint-area counties offer free or cheap coverage to those under 200% (but F lint’s Genesee Co. had to impose a 2 month waiting period on new applicants & may even have to close the plan to new patients). With a $480 million 2012 deficit, the House (once D, but now R) & Senate (still R) again briefly ended adult vision care & must make more cuts in 2011/2. The old legislature sent Granholm a budget restoring adult dental, vision & podiatry (but not hearing aid or chiropractic) care & avoids MD, hospital & most mental health cuts Gov. Snyder (R) said he favors preventive care & pledged not to cut eligibility, benefits or provider fees ---except for a $67 million teaching hospital cut, $21 million in general Medicaid agency cuts & forcing dual elig-ibles into cheaper HMOs. The US-funded risk pool lowered its premiums ($103/mo for the youngest to $415/mo for the oldest), to serve more patients, but to do so had to raise deductibles (up to $3,000) & co-pays (e.g., $10, $20, $50 & $100) 

Minnesota---this 209(b) state has an aged/disabled level of 100%, a regular, full Medicaid parent level of 215%/219% if wkg (‘11), a CHIP level of 275%, an ADAP level of 300% & a risk pool with low income premium discounts for those under 200% & a Medicare supplement. With a $5 billion 2012 deficit, ex-Gov. Pawlenty (R) raised premiums & co-pays for Medicaid , CHIP & MinnesotaCare (state-subsidized insurance for parents under 275% & childless, non-disabled ad-ults below 250%) and denied Medicaid & CHIP to legal aliens. He capped enrollment in HCB care and tightened medical qualifications & cut paid hours for home aides; cut nursing home & HCB waiver fees; raised some premiums; ended cov-erage of occu & speech therapy, audiology & adult dentistry. Hennepin Co. Med Ctr can’t keep giving free care to other counties’ indigents & had to cut dental, mental health & HIV care. He & the (then-D, now-R) legislature compromised to preserve a cheaper GMA, funded at ½ its earlier level. At first, no non-Twin Cities hospitals accepted this new GMA since the grants were below care costs. As authorized by the outgoing legislature (D) & the US health reform law, Gov Dayton (D) expanded US-matched Medicaid to cover GMA patients .(before, 18,000 non-Twin Cities GMA patients had no regular providers & even those seen at the 4 Twin Cities hospitals had long waits for primary care & longer waits for specialists). Some hospitals & managed care plans propose to cut the deficit 33% by forcing the disabled into HMOs. Dayton wants small nursing home & HCB fee cuts & a low nursing home tax, with much of the proceeds to be used to at-tract more US matching to raise rates. The GOP legislative majority proposes  to drop the 100,000 patients added to Me-dicaid by Dayton, plus 7,200 more on Minnesota-Care; give some or all patients $240 vouchers to buy private insurance instead of Medicaid ; reduce MD & HMO fees $300 million & cut $300 million more in services for the aged & disabled.

Mississippi---has no spend down. Gov. Barbour (R) cut the aged/disabled level from $1,000+ to $724/mo (with a $50, not just a $20, disregard) & there are no MSP asset tests. The parent level is 24%/44% wkg (‘11), CHIP’s is 200% & ADAP’s  is 400% (which may be cut to 200%). Only 2 brand Rx’s/mo & 3 generics/mo are covered (but HIV patients get 5 brand Rx’s). Barbour cut phys, speech & occu therapy benefits. An in-person re-application rule limits enrollment; he & the Senate (now tied) won’t drop it, except maybe for LTC, but the House (nominally D) might. After securing new cigarette & hosp taxes, Barbour proposed DDS, nursing home & hospital (but not MD) fee cuts, as well as patient premiums & big-ger co-pays; proposes a 7% mental health cut, lower  mental health center subsidies and closing 4 mental hospitals & 15 mental crisis centers. He won’t use state reserve funds & even enhanced US matching funds to bolster Medicaid (it’s short $34 million). Some disabled children’s parents say the state has tightened Katie Becket waiver medical qualification rules

Missouri---is a 209(b) state. Its risk pool has no Medicare supplement but has a low income premium discount (and the pool director has called for even more affordable premiums). The GOP legislature cut the aged/disabled level from 100 to 85%; ended medical assistance for those awaiting SSA disability awards; cut the parent level to 19%/ 25% wkg (‘11); en-ded adult dental coverage; raised CHIP premiums; denied CHIP to those whose job plans cost under 5% of  income (with exceptions); raised & more strictly enforced co-pays; but kept the ADAP & CHIP levels at 300% & raised the SPAP level (which covers the aged and disabled on Medicare) to 150%. The SPAP law sunsets in 8/11, but Gov. Nixon (D) is cam-paigning across the state to get the legislature (still R) to extend it for 5 more years. Blue Cross & a foundation subsidize insurance for KC-area families under $30,000. The state pays “premium support” for clients’ job plan premiums but won’t give full Medicaid for remaining secondary coverage; restored hospice & working disabled coverage (but the latter covers only those with very low SSDI awards); offers birth control & screenings to women under 185%; restored adult vision (except for the aged in nursing homes), hearing aid & podiatry benefits; and let the aged & disabled opt out of HMOs A court made the state widen notice & hearing rights before closing CHIP cases. The state let community health centers & rural health clinics actually presumptively enroll children in Medicaid & CHIP. Before, only 4 children’s hospitals could do so, although health centers & rural health clinics could help children enroll. Nixon asked the legislature to partially re-store the old 100% parent level (only to 50%); cover all adult dental & vision care; and liberalize CHIP premiums & cov-erage (but it rejected all 3 proposals). Caseload growth forced him to drop plans to restore the 100% aged/disabled level & do more enrollment outreach (in fact, new red tape now impedes enrollment). He sought cuts of $139 million in hospital rates & $32 million in MD & DDS fees & in mental health & public clinic funding; and cut ADAP’s formulary. The state made private plans cover some autism care. CMS said the home health benefit is wrongly limited to the homebound

Montana---has an aged/disabled level of $674/mo (the SSI rate), a parent level of 32%/56% if wkg (‘11), an ADAP level of 330% & a risk pool with low income premium discounts for those under 150% & a Medicare supplement. With a $200+ million deficit, the state raised cost-sharing and cut LTC & hospice benefits and access—and also limited aged & disabled MD visits to 10/yr. But Gov Schweitzer (D) & the legislature (with both Houses now R) ended a CHIP waiting list (yet ADAP has one of 25); seek a waiver to cover more adults; raised the family asset level; set up a SPAP for aged (but not disabled) Medicare patients under 200%; widened CHIP dental & preventive care; and made private plans offer vaccinations & well-child care to age 7. A referendum raised the CHIP level (a 2nd time) to 250% but the children’s enrollment pace has slowed and Schweitzer appears ready to agree to the GOP legislature’s 6% provider fee reduction.

Nebraska---is a Title XVI state with a one-house legislature. Its aged/disabled level is 100%, its parent level is 47%/58% if wkg (‘11) & ADAP’s is 200%. It ended Medicaid for many parents who chose to leave welfare to work, yet the state Supreme Ct forbade denying Medicaid to those who fail to meet work mandates. The risk pool has a Medicare supple-ment but no low income premium discount. Gov Heineman (R) covered Pt. D co-pays for HCB & group home clients & raised CHIP’s 185% level to 200%. With a $340 million 2012 deficit, the latest budget cuts non-primary care Medicaid & CHIP reimbursements 5% ($68 million), raised patient co-pays & may limit dental care to $1,000/yr, hearing aids to 1 ea 4 yrs, eyeglasses to 1 ea 2 yrs & adults to 12 chiropractic visits & 60 occu, speech & phys therapy sessions/yr. The ADAP formulary was cut. When the state Medicaid program dropped pregnant aliens (even legal ones), over 1,500 untreated cas-es resulted in needlessly costly pre-mature births or still-borns—even though the U of NE Med Ctr offered to cover them in its own indigent program. The legislature is now reconsidering its cut. It did widen school health services. Heineman wants to deny Medicaid to welfare recipients who don’t meet his work requirements. The legislature over-rode his veto of the nursing homes’ plan to tax themselves enough to attract more US matching funds with which to then raise their rates.

Nevada---a Title XVI state with no spend down; its disabled level is $674/mo (the SSI-only rate), but the aged-only level is $710.40 (their own higher SSI/SSP rate); its parent level is 25%/88% wkg (‘11); its CHIP level is 200%; its ADAP level is 400%. It subsidizes insurance for parents under 200% working in participating small firms & covers the wkg disabled. Its SPAP, with a 225% level, covers the disabled & even offers a vision benefit; but raised CHIP premiums. With an $8.5 billion 2011 deficit the legislature (still D) capped CHIP dentistry at $600/yr; ended Medicaid adult dental & vision care, CHIP orthodontia; tightened SNF, ICF, HCB waiver & home care medical eligibility rules; and cut pregnancy coverage, hospital rates (closing the U of LV Hosp’s dialysis & oncology units) &  HCB waiver fees and ending attendant funds for the disabled; non-emergency transport, and hospital neonatal, HCB & pediatric specialist fees. The LV-area HIV budget was cut $1 million & many new indigents at low income clinics are causing big budget shortfalls. The state set up a formulary of antipsychotic, anticonvulsant & diabetic Rx’s. Gov Sandoval (R) proposed a $200 million cut in the current budget & a $500 million cut in the 2013-14 budget--reducing Rx benefits $104 million (no details yet), cutting O/P mental health care $60 million & other provider fees by 15 to 43% (for a biennial total fee cut of $58 million).

New Hampshire---a 209(b) state; its risk pool has no Medicare supplement but has low income premium discounts for those under 250%. Its aged/disabled level is $674 (the SSI rate, with a disregard of just $13, not $20/mo). The parent level is 39%/49% wkg (‘11); the CHIP & ADAP levels are 300%. It has a much-stricter-than-SSI “209(b)” Medicaid disability rule (inability to work for over 4 yrs) & doesn’t cover hospices. Gov. Lynch (D) & the legislature (then D; now R again) shifted LTC costs to counties, ended a DD care waiting list, let youths under 26 buy into CHIP & will make more cuts in hospital, MD, LTC & mental health fees (even before the cuts, 2011-2’s deficit was $75 million). US auditors want $35 million in over-claimed DSH funds back & 2010 Medicaid costs ran $43 million over budget. Lynch & GOP legislators back a bill to force all its patients into HMOs, alleging (without any hard  proof) eventual savings of  $32 million a year

New Jersey---has an aged/disabled level of 100%; a 500% ADAP level (but GOP Gov. Christie cut the formulary for cli-ents over 300%) & SPAP levels of $31,850 for 1 & $36,791 for 2. A new waiver adds coverage of  up to 70,000 childless, non-disabled adults with income under $140/mo. The legislature (D) raised the parent level to 200% & ended CHIP prem-iums for those below 200%.  The state cut hospital charity & teaching funds, raised SPAP co-pays and cut its formulary. Christie seeks to drop coverage of legal  aliens, township indigent care funding & coverage of parents over 133%. The le-gislature (still D) opposes his $3 adult day-care co-pay proposal and ending the state’s Pt D wraparound & its co-pay aid & other supplements. He still refuses US birth control, obstetrics and cervical & breast cancer screening funds and vetoed a family planning bill. He plans to meet a $10+ billion deficit by raising cost-sharing; cutting nursing home fees; and pro-posing a 2nd “comprehensive” waiver to “save” $300 million. It’s unclear what that waiver will do. He also plans $240 mil-lion in savings by forcing the rest of the aged & disabled (many are still in fee-for-service coverage) into Medicaid manag-ed care and by handling their pharmacy, home health, medical day care & personal care assistance via managed care too

New Mexico—has no spend down, but has a risk pool with a Medicare supplement & low income premium discounts for those under 400%. Its aged/disabled level is only $674/mo (the SSI rate), its parent level is 29%/67% if wkg (‘11), CHIP’s is 235% & ADAP’s is 400%. A waiver—which is again closed to new individual applicants, but not to small employer groups---subsidizes insurance of any adult (even if childless or non-disabled) under 200%/250% if wkg. The state refuses to process disability-based Medicaid-only applications from those whose disability hasn’t yet been approved by SSA---no matter how much they need medical care. Medicaid’s shortfall could be over $300 million in 2011, so ex-Gov. Richardson  & the legislature (both D) dropped their eligibility expansion plans. The state  may have to end adult dental, vision, hear-ing aid & hospice coverage;  slash phys, occu & speech therapy; cut mental health & substance abuse care & fees; and may cut some Rx coverage & HCB waiver care. Gov. Martinez’ (R) expected health cuts are likely to be even deeper

New York---has a waiver for parents & couples (even if childless) under 150%, and childless (even non-disabled) single adults under 65 below 100% (but the level’s only $761/mo for childless aged singles). ADAP’s level is 431% & CHIP’s is 400%. The state subsidizes insurance for workers under 250%, but caps Rx’s at $3,000/yr. The legislature (D House; R Sen) still excludes the disabled from the SPAP (it has a 350%+ level); won’t cover digital mammograms; raised Rx & MD co-pays (but caps them at $200/yr) & adopted a loose formulary; covers assisted living, chore aide & adult day care. Its counties pay ½ of state Medicaid costs (but their increases are capped at 3.5%/yr); it lets providers deny services to those who don’t meet co-pays; funded HIV day health care; covered colon & prostate cancer patients & wkg disabled below 250%; required hospital discounts for those under 300% & banned taking debtors’ homes; and  passed mental health parity. With a $12+ billion 2011-12 deficit, ex-Gov. Paterson (D) made a $1 billion hospital & nursing home fee cut; started a discount Rx plan for the disabled; raised all Medicaid asset levels ($13,050 for 1, $19,200 for 2, etc); ended MSP & SPAP asset tests; and extended COBRA to 36 mos; proposed a $65 million group home cut (but then a US judge ordered 4,300 mentally ill to be moved into smaller, better facilities) and signed a bill with $775 million in health cuts aimed at saving $300 million more in each future year, pares $72 million from low income health programs & makes big hospital fee cuts. Short $316 million, NYC’s  public hospitals plan to cut child mental health & Rx benefits & close some clinics. NYC proposed to end a school dental program & cut its HIV services $17 million. NYC’s Council de-funded a health insurance advocacy office & St. Vincent Hosp. closed. Paterson had proposed cutting NYC public hospital subsid-dies $370 million & Mayor Bloomberg wants to cut 182 school nurse jobs. Gov Cuomo (D) got the legislature to pass $1 to $2.8 billion in Medicaid & SPAP cuts and will force all Medicaid patents into HMOs A summary of the many very complex cutbacks is in “Medicaid & EPIC Cutbacks…” at HYPERLINK "" or email HYPERLINK ""

North Carolina---covers the wkg disabled, but allows only 8 Rx’s/mo (plus another 3 or more on an exception basis).Its aged/disabled level is 100%; its parent level is 36%/49% if wkg (‘11) & its CHIP level is 200% (the deficit now  prevents raising it). Its aged-only SPAP was suspended in 2010, but may be re-activated in 2011. The legislature (once D, but now R) created a 2 nd SPAP just for ADAP clients on Medicare under 175% but ineligible for Pt D full Extra Help & passed li-mited mental health parity. It started a risk pool that excludes Medicare patients, requires pre-authorization & has a $250 co-pay for “specialty” Rx’s & a $100,000/yr out-of-pocket cap, but does have low income premium discounts. With a $1.2 billion 2011 deficit Gov. Perdue (D) seeks $30 million in drug maker rebates with a preferred Rx list (later adding some psychiatric Rx’s to it); proposed closing 50 state mental hospital beds & cutting MD, hospital, personal aide (plus limiting aide care to 18 hrs/ wk), adult dentistry, maternal care, mental health & community mental health funds (the last by $210 million). The budget cut audiology, speech, physical & occu therapy & hospice funding and ADAP by $3 million (causing a waiting list that briefly hit 811, a formulary that limited coverage to Tier 1 Rx’s & a cut in ADAP’s income le-vel from 300 to 125%). It ends a Medicaid HIV case manager program & coverage of community-based rehab care and many child dental X-rays & sealants; limits breast surgery & coverage of diabetic items to 1 provider; and requires prior approval of X-rays, MRIs, MRAs, PET scans, ultrasounds & some EPSDT services. 2011’s Medicaid shortfall is $475 million. The state found $14.1 million more for ADAP, cutting its waiting list to “only” 194. The hospitals got the legis-lature to tax them over $200 million/yr to attract more US matching to raise their rates & meet other rising Medicaid costs

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 $750, its parent level is 34%/59% if wkg (‘11) but ADAP’s level was cut from 400 to 300%. It cov-ered disabled children under 200% via the FOA, boosted CHIP’s level to 150% & raised the medically needy/spend down level to $750 for 1 person/mo. But the legislature (R) refused to again raise CHIP’s level (to 200%), cut ADAP’s formu-lary, capped enrollment & yearly costs and limited patient access to Fuzeon.  Gov. Dalrymple (R) plans even more cuts.

Ohio--this 209(b) state has a parent level of 90% and cut the ADAP level from 500 to 300% (dis-enrolling 257 clients, triggering a waiting list of 357 and possibly denying eligibility to 861 more with CD4 counts over 500 if their CD4 counts haven’t ever fallen below 200). Then ex-Gov. Strickland (D) shifted $12.8 million in new US Medicaid funds to ADAP to help ease--but not fully overcome--the cuts. Ohio cut its secondary fees for dual eligibles & medical assistance for those awaiting SSA disability awards; moved most patients into HMOs (some with too few specialists); but required private plan mental health parity. Its aged/disabled level is still only $589/mo (the US’ very lowest). Strickland & the old legis-lature (R-Sen; D- House) raised CHIP’s level from 200 to 300% & covered disabled children under 500% via the FOA. He got a waiver to cover assisted living & let over-income children buy into CHIP. He cut nursing home fees (but the legislature then partially restored them & boosted home care benefits); can’t cover digital hearing aids until 7/11; cut Rx fees & com-munity mental health funds; imposed Rx co-pays & a generics preference rule; delayed MD fee raises but restored adult dental & vision care. He told nursing homes to pay for their own patients’ phys therapy, wheel-chairs & medical equip (which some can’t or won’t cover, so some patients may not get needed care or equip). He moved 592 from waiting lists into HCB waiver care & imposed $718 million in fees on hospitals (with proceeds to be used to at-tract more  matching with which to raise rates) & applied state mini-COBRA rights to small firms. Gov. Kasich & the new legislature (both R) plan a $1.4 billion biennial Medicaid reduction: cutting nursing home fees $470 million (but HCB care will sup-posedly be expanded); hospital rates $$478 million, managed care contracts $58 million & psychiatric care $135 million
Oklahoma---this 209(b) state’s aged/disabled level is $716 (the SSI/SSP rate). The parent level is 37% & 53% wkg (‘11) & ADAP’s is 200%. It  won’t cover hospices. The state covered the breast & cervical cancer & work-ing disabled groups & subsidized insurance for students, the unemployed & workers under 200% in qualified small firms. The legislature (R) later cut the insurance plan premiums & eligibility but also cut its benefits; cov-ers assisted living, raised the CHIP level from 185 to 300%; favors HSAs in employer plans; and gutted the ins-urance minimum benefits law Gov. Fallin (R) may drop pregnant women’s dentistry, durable medical equip & nebulizors and cut dialysis, diabetic supply, hospital, MD & nur-sing home fees;  raised some co-pays; seeks to limit ER visits to 3/yr; cut mental health care; closed 200 mental hospital beds; cut covered brand Rx’s from 3 to 2/mo and ended speech, occu & phys therapy benefits. The hospitals got the House to pass a hospital “assess-ment” to attract more US matching & the Senate voted to use $15 million in unspent ARRA funds on Medicaid.

Oregon---this Title XVI state’s risk pool has no Medicare supplement but has low income premium discounts for those under 185%. Income levels are $674/mo for aged & disabled (the SSI rate), 32%/40% wkg for parents (‘11), 185% for insurance subsidies for non-Medicare adults (with enrollment closed) & 200% for ADAP. An anti-tax referendum cut el-igibility & adult dentistry and ended adult vision care. With a $577 million 2011 deficit, the OR Health Plan expansion waiver--with limited Medicaid for non-Medicare adults under 201%--again froze enrollment. ADAP has cost-sharing. Ex-Gov Kungoloski & the legislature (both then D) took the FOA option & passed insurer & hospital taxes--later upheld in a referendum that also raised taxes on the rich--to cover 80,000 more children, raise CHIP’s level to 300%, cover another 35,000 adults & offer more home care---yet he later had to end home care for 100s of cases. Gov Kitzhaber & the Senate (both D) want to expand coverage but have to cut provider fees 16 to 19%, while the new House is tied between Ds & Rs.

Pennsylvania---has an aged/disabled level of 100%, a parent level of 26%/46% if wkg (‘11) & an ADAP level of  350%. It subsidized “AdultBasic” insurance for non-Medicare adults under 208% to 213% if wkg (with no mental health or Rx benefits , and had 496,000 on its waiting list. Ex- Gov. Rendell (D) covered the wkg disabled, raised the SPAP level (to $23,500 for 1 & $31,500 for 2, covering 90,000 more aged, but still excludes the disabled). Gov Corbett (R) & the new legislature (both Houses are now R) want to drop adult dentistry, cut mental & women’s health services; oppose any ex-pansions; and abolished the Adult Basic program on Feb.28. (But reviews of income & medical records suggest that nearly half the patients may well be eligible for Medicaid & they’ve been so informed by letter, according to Community Legal Services of Phila.). The 2012 deficit is $4 billion. Phila city clinics now charge $5-$20 a visit. Rendell discounted premiums to as low as $283/mo for those under 200% in PA’s US health reform-funded risk pool, but HHS refused his plea to waive the US risk  pools’ 6 months-with-no-coverage rule even for those Adult Basic patients left uncovered.

Rhode Island---has these income levels: aged/disabled, 100%, parents, 175% (181% wkg), CHIP, 250% & ADAP 400% (it was cut to 200%, briefly causing a waiting list). The state covers the wkg disabled & its limited formulary SPAP covers the aged but only those disabled over age 55 (with levels of $37,167 for 1 & $42,476 for 2). Ex-Gov Carcieri (R) required free & discount hospital care for those under 200% & 300% and banned taking debtors’ homes. Big deficits ($107 million in 2011) moved him to get a waiver with extra up-front US funds; in exchange it requires shifting 12% of nursing home cases to cheaper home care & caps future US funds. The legislature (D) raised adult daycare co-pays; dropped coverage of legal alien children.& ended childcare workers’ insurance. Gov. Chaffee (I) is expected to have a moderate health policy.

South Carolina---has no spend down. Its aged/disabled level is 100% & its parent levels are 50%/93% if wkg (‘11). It
cut its ADAP level to 300%. Its risk pool has a Medicare supplement but no low income premium discount. Ex-Gov San-
ford & the legislature (both R) limited Rx’s to 4/mo & raised CHIP’s level to 200%. The SPAP has a 200% level but ex-
cudes the disabled. The state cut mental health benefits, closed an HIV program to new clients & slashed home health,
hospital & nursing home fees. Yet it passed private plan mental health parity. It also ended SPAP payments for drugs not
covered by Pt D, cut SPAP funds & ended state ADAP funding  dropping 200 patients & may drop 200 more, even with
a waiting list already at 612), cut home, personal aide, HCB care (the last 3 face court suits) & covered Rx’s from 8 to 7
mo & de-funded cancer screening.  Gov Haley (R) planned to end hospice coverage (but then relented). She cut speech
speech therapy sessions from 225 to 75/yr. For now, the state won’t impose more cuts in spite of a $200 million deficit
that’s soon rising  to $1 billion. Haley plans to save $200 million more with” public-private care provider partnerships”.

South Dakota---has no spend down. Its aged/disabled level is $674/mo (the SSI rate), its parent level is 52%, wkg or not (‘11) & ADAP’s is 300%. Rejecting a call for expansion, the legislature (R) refused to raise the pregnant women & CHIP levels to 250% or increase provider fees & ended adult dental coverage.  Gov. Daugaard (R) pledged to make $30 million in Medicaid cuts (including 10% provider fee cuts), but the legislature restored $12.5 million to soften providers’ fee cuts.

Tennessee—Ex-Gov Bredeson (D) & the legislature (R) set the aged/disabled level at $674/mo (the SSI rate), parents’ at 70%/127% if wkg (‘11) & ADAP’s at 300%. Except for the pregnant, children & HIV+ patients, MD visits were cut to 10/yr, hosp days to 20/yr & Rx’s to 2 brand drugs + 3 generics/mo, except for some grave conditions. There’s a 250% CHIP level, a risk pool (with no Medicare supplement but with a premium discount for those below 250%), a SPAP (with a waiting list & low benefits cap) covering up to 5 generics/mo for non-Medicare patients under 250% & subsidized bare-bones insurance for non-Medicare adults under $55,000 (enrollment is closed). CHIP uses Medicaid Rx rules, but also co-vers diabetic items & more psychiatric Rx’s. Home care & medical equip benefits were cut. Bredeson made big mental health cuts & a $500 million hosp rate cut —forcing Nashville Gen Hosp to deny non-emergency care to indigent illegals. He deferred caps on MD visits, transportation & transplant care, kept a $10,000/yearly benefits cap; limited occupational, speech & physical therapy benefits; and capped X-ray & lab usage and ADAP costs. A court voided its 1987 order grand-fathering-in 150,000 ex-SSI recipients to Medicaid (see “Daniels Case” at HYPERLINK "" ). Gov. Haslam (R) favors cutting Medicaid costs by excluding coverage of caesarians and hemophilia, detoxification, acne & some sedative drugs.

Texas—has a risk pool with a Medicare supplement & but no low income premium discount .The aged/disabled level is  $674/mo (the SSI rate), the parent level is 12%/26% wkg (‘11) & the ADAP & CHIP levels are 200%. Gov. Perry & the legislature (both R) dropped  CHIP prostheses, phys  therapy & private duty nursing; raised CHIP cost-sharing; cut Med-icaid home health & ended adult chiropractic & podiatry care; capped the number of Rx’s covered monthly; moved pa-tients into HMOs; but restored Medicaid mental health, vision & hearing aid coverage and CHIP mental health & dentis-ry (Medicaid also covers some adult dentistry); required some mental health parity in private plans & set up a SPAP for HIV clients. A non-profit ( HYPERLINK "" ) fosters subsidized cheap health plans for workers under 300% in small firms in the Waco, Dallas, El Paso, Ft. Worth, Galveston & Houston areas. A court order to improve child health & EPSDT requires higher MD & DDS fees (but even so, Perry plans a 10% provider rate cut). The 2011-12 deficit is $25 billion. The legislature cut the Children with Special Health Needs program--plus a cystic fibrosis aid program for all ages--by $3.5 million (even with 950 children on a waiting list); denied funding for 13,000 HCB waiver slots; & auth-orized cutting the ADAP level from 200 to 125%  if necessary--even though 15,000 patients already rely on TX ADAP.

Utah—is a Title XVI state with a risk pool that has a low income premium discount, but no Medicare supplement. Its aged/disabled level is now 100%, its parent level is 38%/44% if wkg (‘11) & CHIP’s is 200%. A waiver—now closed to new patients--gives limited O/P care, with big co-pays, to non-Medicare adults (even if childless & non-disabled) under 150%. The legislature (R) ended coverage of  podiatry, audiology, speech therapy, chiropractic, outdoor wheelchairs and adult eyeglasses & dentistry (one patient’s untreated tooth infection spread fatally to her brain); cut hospital & DDS fees 25%; but subsidizes insurance for workers under 150% in participating small firms. A legislative panel called for gutting the mini-mum benefits law. a ban on pre-existing condition rules; and urging employers to offer HSAs instead of regular insurance--and the state let insurers sell even-cheaper-than-COBRA, barebones policies. Gov. Herbert (R) restored dental care for children & pregnant women and some phys & occu therapy. Yet he & the legislature cut DDS fees again (which CMS then disapproved); until recently had an ADAP waiting list of 143 and cut its formulary & income level (to 250%, dropping 89 more clients); It may cut the disabled level from 100 to 74%, school health funds & the pregnant women’s asset level & even drop the spend down. Herbert will sign a bill to force Medicaid patients to “work” for their benefits.

Vermont—Its levels are: aged/disabled (2 zones) 101% & 110%; parents, 185%/191% if wkg (’11); childless, non-disabled adults, 150% /160% if wkg; CHIP, 300%; ADAP, 200% & the SPAP, 175%. There are no MSP asset tests. The state subsidizes insurance for others under 300%. Dentures still aren’t covered & there’s a $495/yr dental care cost cap per adult patient. A waiver, in return for more US funds, moves patients into HMOs & favors HCB care over nursing homes--but also caps future US matching funds. The 2011 health & welfare shortfall is $53 million. Ex-Gov Douglas (R) prom-ised not to cut eligibility (and even signed a bill requiring more private plan autism coverage), yet raised SPAP co-pays & sought more client cost-sharing (but the Democratic legislature blocked CHIP premiums), a cap on allowed ER visits and provider & Rx fee cuts. Gov Shumlin (D) favors a single payer health expansion & the House even voted for such a plan.

Virginia---this 209(b) state’s parent level is 25/31% if wkg (‘11), CHIP’s is 200% & ADAP’s is 400%. It covers the wkg disabled & has a SPAP for HIV+ Pt. D patients under 300%. With a $4 billion deficit, Gov. McDonnell & the House (both R) ignored gentler Senate (D) proposals to cut provider fees & mental health, substance abuse & community care funds, lower the $2,200/mo HCB waiver level to $1,685, even with a HCB waiting list of 6,000 (but $30 million was later found for HCB care); cut CHIP’s level from 200 to 175% (which will turn away 28,000) & aged/disabled level from 80 to 75%.  ADAP’s $12.6 million deficit required a formulary cut, closed enrollment & dropped 760 patients (except pregnant women, children & those with CD4 counts under 350 or who’ve had opportunistic infections). The waiting list was already 57 & even after McDonnell & the legislature added more state funds ($3.6 million the 1st yr & $2.6 million the 2nd yr of the biennium), it still rose to 616 (and may rise by 760 more). A bill passed to make big firms’ health plans cover some autism care–-and McDonnell’s line-item veto amendment to reduce coverage & employer costs was over-riden. 

Washington--its risk pool has a supplement open to some, but not all, Medicare patients. Its aged/disabled level is $720 (the SSI/ SSP rate), its parent level is 37%/74% if wkg (‘11) but ADAP’s 300% level was cut to 275%. Gov. Gregoire & the legislature (both D) passed mental health parity. Budget cuts forced her to end CHIP for 27,000 undocumented chil-dren. The state raised BasicHealth (its subsidized insurance for non-Medicare adults under 200%, with a waiting list of 150,000) premiums & co-pays, forcing 60,000 off the rolls; ended medical assistance for 21,000 disabled clients; cut DSH payments & nursing home fees; and limited Rx, DME, imaging, denture, diabetic supplies, personal aide, home care, adult day care, maternity & infant casework & incontinence benefits and cut druggist, pediatric MD, HMO & day health center fees. It dropped adult hearing aids, podiatry, eyeglasses, dentistry, & colorectal cancer screening. A referendum to place income taxes on the rich lost; instead, some existing taxes were even repealed. ADAP’s formulary was cut, cost-sharing was imposed, it may have to drop 500 clients & 25% was cut in other HIV care. The state offers slightly discounted, un-subsidized insurance. A  Medicaid waiver provides matching for BasicHealth & Disability Lifeline  medical assistance but the state had to cut 17,000 from BasicHealth for not meeting immigrant status, having income over 133% or being over 65

West Virginia---has an aged/disabled level of $674/mo (the SSI rate), a parent level of 17%/33% if wkg (‘11) & a 250% ADAP level. It covers only 4 brand Rx’s/mo (plus 6 generics). Its risk pool has no Medicare supplement but low income premium discounts have been authorized. It denies all adult dental care but extractions & emergencies & didn’t properly adopt nursing home & HCB medical admission rules (which still impede access). Ex-Gov Manchin & the legislature (both D) started an Rx aid plan for non-Medicare adults under 200%. CMS is trying, over state objections, to halt a waiver that offers clients more mental health care & Rx’s--but only if they sign “personal responsibility” pledges. Manchin raised the CHIP level to 250% but planned to put the disabled, parents & children into managed care that some say cuts care access. Gov Tomblin (D) & the legislature passed a hospital tax with proceeds to be used to attract more US Medicaid matching. 

Wisconsin---has an aged/disabled level of $757.78/mo (the SSI/SSP rate),a 300% ADAP level & a 240% SPAP level  (which excludes the disabled). The risk pool has a Medicare supplement & premium discounts for those under $33,000 Ex-Gov Doyle & the old legislature (both D) raised the CHIP (185 to 300%) & parent (185 to 200%) levels & funded “Basic Care” for up to 64,000 non-Medicare childless adults under 200%. But its caseload now exceeds funding capacity (with 80,000 more on a waiting list).  In 2012, the state needs $675 million more for health assistance (and has a $2.7 bil-lion deficit) but Gov. Walker & the new legislature (both now R) oppose US health reform, even minimal Exchange rules or regulations & any coverage expansions: They plan $3 billion+ in Medicaid cuts, including dropping over 44,000 child-less, non-disabled adults. He signed a Republican-pased bill to give him sole power (reviewable only by a rubber-stamp GOP- stacked legislative panel) to change Medicaid & other health programs’ eligibility, cost-sharing, benefits & pay-ment laws & policies in order to cut costs $500 million yearly (he then began by dropping those 44.000 from Basic Care

Wyoming--has no spend down, an aged/disabled level of $699 (the SSI/SSP rate), a parent level of 39%/52% if wkg (‘11) & a 200% CHIP level. Its SPAP covers non-Medicare persons below 100%. The legislature (R) widened CHIP mental health, vision & dental benefits. Ex-Gov Freudenthal (D) added a risk pool low income premium discount for those under 250% (it already had a Medicare supplement) & finalized plans with GOP legislators to offer cheap, subsidized---but limi-ted---preventive-oriented insurance for working adults under 200% during 2011. Medicaid‘s 2010 costs rose $100 million & its next year’s budget shortfall is $192 million--so the state plans to cut most provider fees $25 million, the DD & HCB budget by $3.6 million (freezing-in a waiting list) & state dialysis aid by $250,000. ADAP’s 332% income level was cut, its formulary & enrollment were capped & it again has a waiting list (only 4 so far). Gov. Mead (R) plans more health cuts

Email HYPERLINK "" for “State Asst. Programs For SSI Recips., 1/10” (the latest update) on state Medicaid eli-gibility rules for SSI & SSP recipients, state SSP amounts and state Sec. 1616, 1634 & 209(b) eligibility arrangements.

For the 48 states & DC, 2011’s federal poverty level (FPL) is $10,890/yr ($907.50/mo) for one plus $3820/yr ($318.33/mo) for each add’l person; see the Assistant Secretary for Planning & Evaluation pages at HYPERLINK "" for prior years’ FPLs  and AK’s & HI’s separate & higher FPLs. The basic federal 2011 SSI rates (not including any state supplementary  payments, or SSPs) are the same as in 2009 & 2010: $674//mo for 1 & $1,011/mo for couples.

Sources on state parent & childless non-disabled adult income levels are “Holding Steady: Looking Ahead.. 50-State Survey of Elig. Rules.. [for Parents & Childless Non-Dis Adults]..2010-11” [pub.#8132, Tbls B, 4 & 5], “Medicaid..[& MSP]..Elig..[Levels]  ..for..Elder[s]&..Disab[led] 2009-10 ..”[pub #8048, Tbls 1 & 6] in the Medicaid pages at HYPERLINK "" & HYPERLINK ""   for more 2010-11 aged/disabled elig. data (App. A4a).

“Medicaid Expansion Now..[Can]..Save..States Money” ( 4/1/10) at HYPERLINK "" shows states can add to their health budgets by now getting regular US Medicaid matching rates for previously 100% state-funded medical assistance for childless, non-disabled adults under 133% FPL; and “Explaining: Benefits & Cost-Sharing… States Can Set For [New] Medicaid [Eligibles].” ( 8/9/10) For CMS rules on covering new clients see State Med Dir Ltr #10-005, “New Options..Under Medicaid”(4//10/10) & State Med Dir Ltr #10-013 (7/2/10) on required “Family Planning & Benchmark [plus mental health & Rx] Coverage” at HYPERLINK ""

“Medicaid Cov. & ..[Costs] Health Reform..” at HYPERLINK "" projects numbers of new Medicaid patients & states’ tiny share of their costs starting in 2014 (0% to 10%).See “ The States’ Next Challenge: ..[Getting]..Primary Care to..[more..Medicaid..Patients..]” in the “New Eng. Jour. of Medicine” (2/10/11).

“Net Effects of the Afford. Care Act on State Budgets”at HYPERLINK "" sees state savings of $40.6 to $131.7 billion from health reform yearly in 2014-19. The ADA & HHS regulations issued on April 15, 2011 gives them a 90% federal match to set up & improve Medicaid & Exchange enrollment systems & a 75% federal match to run them (the old Medicaid administrative match—including eligibility—was only 50%)

See “Republican Report Inflates State Medicaid Costs [In] Health Reform”at HYPERLINK "" , “Medicaid & the ACA: Reframing the Debate”at HYPERLINK "" ; HYPERLINK "" & HYPERLINK "" on state costs & savings; and “Medicaid’s Role in..Health..Exchanges: A Road Map for States” at HYPERLINK ""

The ACA “Maximiz[es].. [Primary MD].. Medicaid Rates to Medicare Levels [to get more primary care MDs to take Medicaid]..” at HYPERLINK "" by paying 100% of the added fee costs in 2013 & 2014.

HYPERLINK "" lists state chiropractor, podiatry, eyeglasses, optometry, hearing aid, hospice, psycholog-ist, prosthetics, home health, medical equip, dental, Rx’s, OTC items & phys, occup & speech therapy coverage, 2003-8

The “National ADAP Monitoring Report, 2010” at HYPERLINK "" lists state income eligibility levels in Table XVI & their policies to coordinate with Part D in Table XIX. It covers state cost sharing rules & medical criteria and/or prior authorization rules for special or costly drugs. State co-pay policies are in Charts 27 a & b and their formularies are in Table XXI. See its “ADAP Watch” on waiting lists & “ADAP Pill Box” at HYPERLINK ""     

See “Pharm. Benefits [in] State [Medicaid]” at HYPERLINK "" on formularies, fees, prior auth, prescribing/dispen-sing limits & co-pays. HYPERLINK "" has a chart on how Rx maker PAPs mesh with Pt D. States can cover Pt-D-excluded Rx’s with their own funds: see which do so at HYPERLINK " D_ExcludedDrugsbyState.htm" (12/1/05 rpt. at “News” icon). National Public Radio (NPR)  reported on 4/20/11 that 75% of prescriptions written and used in the United States are now for generics.

“Medicaid Managed Care Trends” (2009) on the Medicaid research/demonstration pages at HYPERLINK "" shows that over 70% of Medicaid patients are already enrolled, often mandatorily (e.g., non-disabled parents & children, except in the most remote areas) in managed care;  but, with their budget crises, most states now plan to enroll (often mandatorily) even the so-far-mostly-exempt aged & disabled as well (often even nursing home & DD patients in specialized programs 

See “Indiv..Models of LTC’ at HYPERLINK "" for state coverage of Home & Community-Based waivers, home health, personal aides for the disabled; a get 2009 list of state Personal Needs Allowances (PNAs) for SNF & ICF patients and residents of state-licensed SSI/ SSP-funded board & care homes from HYPERLINK "" . Also see “Medicaid HCB Services Data Update: 2011” & a “Money Follows the Person Snapshot, 2010” at
  See HYPERLINK "" on the pre-health reform state risk pools & order “Comp. Health Ins. for High Risk Indivs: .. State-by-State…”on funding, eligibility, benefits, Medicare supplements, premiums & low income premium discounts. HYPERLINK "" shows if new US health reform-funded risk pools are state- or federally-run & their premium amounts.

See the “Directory of..[the 27]..State Kidney Programs” with contact, eligibility & benefit data under “publications” at HYPERLINK "" . FL, MI, NJ & TX health depts. also have epilepsy and/or hemophilia aid programs

See ”From CANN ” in “Other Organizations’ Materials” under ”Medicaid” below “Issues” at HYPERLINK "" for a Medicaid “Glossary”, “2011 VA Health Benefits” and ”Painless Ways To Deal With State Medicaid Shortfalls”.

The Ryan White CARE Act, Title II, Community AIDS National Network, Inc.

Thomas P. McCormack
MedicaidWatch - supported by unrestricted educational grants from GlaxoSmithKlien, Abbott Laboratories, Amgen, Gilead Sciences, Merck & Co., Bristol Myers Squibb, Boehringer Ingelheim & Tibotec Therpeutics

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 William E. Arnold

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Eric Camp
Donna Christensen MD MOC
Jeff Coudriet
Wayne A. Duffus MD PhD
Richard Fortenbery
Thomas J. Fussaro
Kathie M. Hiers
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Gary R. Rose, JD
MikeLynn Salthouse RN
Michael G. Sension MD
Katherine C. Stuart
Michael J. Sullivan
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