Democrats push back against Medicaid service cuts

Feb 8, 2012

Florida Democrats are voicing their displeasure with several budget cutting proposals under consideration before the full chamber. Republicans have a veto-proof majority in the legislature, but as Lynn Hatter reports, that didn’t stop the minority party from launching a series of criticisms --thinly disguised as questions— to try and poke holes in the Houses healthcare budget plans.

State Republican Representative Matt Hudson is the House’s chief healthcare budget architect. This year the House has targeted Medicaid services as places for reductions. And that includes limits on Emergency Room visits and adult services.  But those kinds of cuts don’t sit well with Hudson’s colleagues in the other political party, like Representative Gwendolyn Clarke Reed—who wanted to know why the state would cut podiatric services for adults.

“ I have a lot of people in my district who are diabetics. And they need that podiatric—the foot doctor. They need to be able to go to him on a regular basis. Are you saying that you’d rather they amputate the limb, or the foot?”

Here’s Hudson’s response:

“No certainly I’m not advocating we advance the notion of amputations. I would think that anyone with a chronic disease state like diabetes, as they work through their healthcare concerns with their primary care physician, that their primary care physician would be advocating and administering the proper care necessary for them to manage their disease state so we wouldn’t get to that position.”

Hudson reiterated the theme of personal responsibility when Democrat Elaine Schwartz questioned the cut in hospital admissions. Under the House’s healthcare proposal, adults on Medicaid wouldn’t be able to go to the Emergency room more than 12 times a year. And Schwartz wants to know how that’s supposed to work. She cites an example of a person with asthma, who may have more than 12 attacks that send them to the hospital:

 “These people will still go to the Emergency room. They may be on Medicaid, but the hospitals cannot turn them away. And we will actually pick up the tab fully. These people will not go away.”

 To which Hudson replies:

 “I believe that people should be responsible for their healthcare. And if you have a chronic disease state that’s a recurring problem ,be it asthma, high blood pressure what have you, your primary care physician has given you the appropriate medications for you to maintain your disease state and make sure you are functional. And you have a responsibility to take your medication and do what’s right for you.”

The issue of limiting Medicaid services for adults and reducing hospital admissions comes from the Agency for Healthcare Administration. It made the suggestion last year after it was told to prepare for a 10-percent budget reduction. Three-quarters of the agency's budget goes to services. So, to reach the 10-percent threshold, AHCA suggested eliminating services like chiropractic and podiatry care, along with limiting the number of emergency room visits. Those are some of only a handful of service programs the state CAN cut out of Medicaid without running afoul of federal law.  But Democrats like Representative Steve Perman of Boca Raton who’s also a chiropractic physician, say just because those services can be limited, doesn’t mean they should be.

 “In light of the fact that the federal government has designated chiropractic services as a central and unique services for both Medicare and active military, did you take that into account when you chose to eliminate those services under this program?"

Hudson: “When the federal government puts their money where their mouth is and changes the Medicaid statute to make it a mandatory function rather than an optional function, we’ll take a look at it.”

Meanwhile, as the House gets closer to finalizing its budget proposal, the Senate-version is still a work in progress. Hudson’s Senate counterpart is Joe Negron. Instead of cutting services, Negron wants to cut low-performing programs that deal with mental health and substance abuse. He’s also trying to keep ALL Medicaid services intact for adults, instead of following the House on the cut to podiatry and chiropractic care. However, the two chambers are in agreement on limiting the number of times Medicaid patients can go to the Emergency Room for non-emergency visits to 12.