Medicaid revamps spark access worries

Physicians fear that overhauls in two state programs are signs that large eligibility cuts or other harmful measures may be coming in other states.

By Joel B. Finkelstein, AMNews staff. Jan. 31, 2005.

Washington -- Sweeping proposed changes in Tennessee's and Florida's Medicaid programs have raised concerns that states are moving from smaller cuts to major overhauls to rein in growing costs in this area. Physicians worry that, as a result, hundreds of thousands of people will lose health coverage and that doctors' ability to care for patients will be harmed.

"It's probably the short-term wave of the future, but it's all going to blow up in our faces very quickly," said Georganne Chapin, president of Hudson Health Plan, a nonprofit managed care company serving Medicaid patients in New York State.

Some doctors fear that reform talks at the federal level will further encourage states to take drastic steps that will mean the loss of coverage among the working poor.

Governors and various national and state medical and advocacy groups are already trying to head off talk of capping the amount of federal Medicaid money. Such limits could exacerbate states' funding problems and force more program cuts.

The American Medical Association opposes cuts to Medicaid eligibility unless accompanied by broader health insurance reforms that allow more low-income individuals to obtain other coverage.

The nation's most generous Medicaid program, TennCare, which currently serves one in four Tennessee residents, provides perhaps the most prominent case of fallout from the states' financial difficulties and a troubling harbinger for what is in store for Medicaid, experts said.