It’s a time-consuming and tedious, yet necessary, process. When for a variety of reasons the kidneys stop functioning properly, dialysis is the procedure that keeps many alive. As an outpatient procedure, dialysis has been around since the 1960s. It usually requires an individual to go three times per week to an outpatient facility and sit for about three hours connected to an ATM-looking machine that does what a person’s body can no longer do: remove waste products and toxins, along with excess fluids, from the bloodstream. For those with chronic kidney issues, it’s a life-saving treatment.
For Medicaid patients in Alabama who receive dialysis, their thrice weekly trip to an outpatient center will soon be replaced with trips to the emergency room to undergo the treatments. Doing so will, on average, triple the cost of the procedure, adding a huge financial burden for hospitals that will have to absorb the costs of treating patients who won’t be able to pay them back. The low-income patients themselves will now have their lives hanging in the balance if they don’t receive treatment.
Unfortunately it’s an inevitable consequence of the 2016 budget recently passed by the Alabama Legislature. With the budget’s exclusion of $85 million in additional funding for Medicaid, coverage of outpatient dialysis treatment and other services will soon come to an end.
Medicaid, the 50-year-old government-sponsored program, was put in place to provide health care services to low-income citizens. It also serves as a core source of financing for “safety net” health centers and hospitals that serve the economically marginalized — the poor.
Within federal guidelines and requirements, individual states design and administer their own Medicaid programs. The federal government and states jointly fund Medicaid, but the federal government bears the lion’s share of the cost. In Alabama the percentage ratio is about 70/30, with 30 percent being the state’s share.
Out of Alabama’s 4.8 million inhabitants, just below 25 percent, or around 1 million, are Medicaid recipients. The overwhelming majority of Medicaid recipients in Alabama are children (about half) along with elderly citizens and the disabled.
Because Alabama opted not to expand Medicaid, a working-age healthy adult without dependent children is not eligible to receive Medicaid health care benefits. Particularly in states like Alabama with entrenched poverty, the program has been a lifeline for many.
In Alabama this health care “safety net” program is coming apart at the seams. Not only will outpatient dialysis be eliminated, but a host of other services such as prescription drug coverage, prosthetics and orthotics, vital elderly care programs such as PACE (Program of All Inclusive Care for the Elderly) and the Health Home and Physician Case Management program, which greatly reduces the state’s nursing home population, will get the axe as well.
The cuts would also reduce reimbursement rates for outpatient surgical centers, dentists, doctors, hearing and other programs, thereby reducing access to these specialists for Medicaid recipients. Kimble Forrister, executive director of Arise Citizens’ Policy Project, a state public policy organization, noted, “We can’t build a stronger Alabama by taking a sledgehammer to the foundation of our state’s health care system. But that’s just what this inadequate General Fund budget would do.” Many health care providers around the state are sounding the alarm at the dire consequences the state now faces.
Dr. David Gremse, chair of the University of South Alabama College of Medicine’s Department of Pediatrics, told me, “There is tremendous concern among pediatricians about the prospect of Medicaid cuts. Many are concerned they will have to reduce services or close their practice. The population of Alabama is not large enough to support many pediatric subspecialists in practice only seeing patients with commercial insurance. Almost all pediatric subspecialists in Alabama see patients with Medicaid. Cuts in Medicaid funding may cause pediatric specialists to leave the state.”
It’s serious. The cuts would jeopardize matching federal funds that are based on the state maintaining minimum spending levels and having adequate physician coverage throughout the state. The loss of those federal funds could undermine the whole system. If that happens, it wouldn’t just be state Medicaid recipients who would suffer.
Medicaid has been referred to as the “backbone” of health care in Alabama. Many hospitals and clinics serve Medicaid patients, some to a significant degree. If they have to cut staff and services, or close altogether, this would also affect those who pay for their health care plans.
What good is it to have insurance when you have no medical facilities or services close by? This could become a reality for many communities throughout the state. Dr. Gremse observed, “Although many Alabamians do not depend on Medicaid for their health care coverage, Alabama’s hospitals and doctors heavily depend on Medicaid.”
Back in February, Gov. Bentley said he felt implementing a lottery would be the only viable way to raise additional money for Medicaid. He also stated during that time, he would veto any budget that did not fund Medicaid at the $785 million level he requested.
The Legislature gave Medicaid $700 million. He vetoed their budget and the Legislature overrode his veto. Scandal ridden and without a credibility or moral leg to stand on, it’s doubtful the governor will call a special session to address the lack of funding. And even if he did, he just has no political clout to get anything done.
No lottery legislation has been passed. The viability, indeed the very existence of the Medicaid program in Alabama, is perched over a deep, dark and destructive abyss. Time is nudging it into it.
Some in Alabama feel its demise would be OK, a welcome fiscal relief. Unfortunately, we will soon see if they’re right.
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