New law lets states get tough on benefits for Medicaid patients

Idaho, Kentucky and West Virginia reform their Medicaid programs, limiting benefits and demanding healthy lifestyles.

By Elaine Monaghan, AMNews staff. June 12, 2006.

Washington -- States have begun to take advantage of a new federal injection of flexibility into Medicaid programs. Physicians are supportive of the goal -- to preserve Medicaid systems near the breaking point. But proposals to limit benefits to vulnerable patients, including children, are causing concern.

Idaho, Kentucky and West Virginia are the first to respond to the Medicaid provisions in the Deficit Reduction Act, signed into law in February.

The Dept. of Health and Human Services last month announced that the states had received approval for Medicaid reforms that would offer incentives for healthy lifestyles, impose new patient co-pays or, in the case of Idaho, offer a voluntary alternative to the existing Medicaid program.

West Virginia had the most controversial plan, requiring patients to sign an agreement promising to obtain screenings as directed by doctors, adhere to health programs, attend doctors' appointments and take prescribed drugs. In return they would get coverage for tobacco cessation programs and nutritional education, diabetes care, and mental health and chemical dependency services. Those who break the contract could lose these benefits by being demoted to a "basic" package.

Idaho offered similar incentives but no punishments.

Kentucky, meanwhile, provoked concerns from its state medical association by limiting the number of prescriptions to a monthly allowance of four, only three of which could be brand-name drugs. West Virginia's plan has similar restrictions. Waivers are available, but doctors are concerned about a lack of detail on how such exemptions will be made.