Bentley, Azar paint grim picture for Medicaid

Gov. Robert Bentley and Medicaid Commissioner Stephanie Azar on Wednesday laid out a stark picture of the impact of the Medicaid budget approved by the Legislature, including the elimination of many services, cuts to physician reimbursements and elimination of drug coverage for adults.

“I think it’s important for recipients to know their access to care is at risk, and for Medicaid providers to prepare for the impact of these cuts, because this is the budget for Medicaid at this point in time,” Azar said at a press conference in the Old House Chamber on Wednesday.

At the same time, Bentley acknowledged the issues in trying to convince the Legislature – where Republicans criticize Medicaid for taking state money from other programs – to create more revenue for the General Fund budget, and stepped back from a threat to call the Legislature into special session to address the funding problems.

“I have some ideas, but if the Legislature is not interested in those, they’re the ones that have to present me with the amount of money,” the governor said Wednesday. “They allocate, and I carry out the executive part of (being) governor, which is to make sure what we have works.”

The Legislature overrode Bentley’s veto of the $1.8 billion General Fund budget Tuesday, which sets the budget to go into effect on Oct. 1. Azar said Medicaid needed an increase of $100 million in state funding – from $685 million to $785 million – to maintain services and to begin implementation of regional care organizations (RCOs), a managed care model for Medicaid with the goal of slowing cost growth.

The Legislature raised Medicaid’s allocation by $15 million amid criticism that growth in the program was cannibalizing the budget. Senate President Pro Tem Del Marsh, R-Anniston, said Tuesday he saw no interest in raising taxes or making transfers from the Education Trust Fund budget to shore up the General Fund.

“We weren’t going to take money from education, and we weren’t going to raise taxes,” Marsh said Tuesday night. “So it made no sense but to override the veto.”

Azar said to make up the gap, Medicaid would cut a primary care bump that allows physicians taking part in Medicaid to receive the higher Medicare reimbursement rates, a key part of keeping doctors in the program. Azar said cutting that would bring them down to rates that have not changed since 2005, and that cuts below that were possible. Many physicians in Alabama, particularly pediatricians, depend on Medicaid to stay open, and Azar says those cuts could hurt those with private insurance.

“My pediatrician may leave this state,” she said after the press conference. “My optometrist may leave this state, or my dentist may leave this state.”

Medicaid would also cut adult eyeglasses, outpatient dialysis and prosthetics and orthotics, among other programs. Losing physicians could also drive more patients to emergency rooms, straining hospitals' resources.

The commissioner also said they would cut drug coverage for adults and implement a pharmacy preferred provider program. Under the program, Medicaid recipients would have to go to a single provider – like Walmart, Walgreens or another chain- type store – to get their medications.

Bentley and Azar said they did not have a timeframe for implementing the cuts though Azar said “whenever the governor decides to make those cuts” Medicaid will put them in place.

Medicaid in Alabama mostly covers children, the elderly and the disabled. Able-bodied adults only qualify for services if they have a child that qualifies for Medicaid and if they make 18 percent of the federal poverty line – about $2,884 a year for a family of two, and $4,374 a year for a family of four. Despite the limits, more than 1 million Alabamians, about 22 percent of the population, were eligible for Medicaid last June.

The governor did not rule out a special session on Medicaid entirely, but said he would make a decision soon.

“They’re going to have dramatic results, bad results for those involved,” Bentley said. “We’ll make those decisions over the next few weeks.”