Medicaid Drops Thousands

State announces eligibility cuts

Recently proposed Medicaid qualification standards would leave around 4,500 without health insurance around Hawaii. The state Department of Human Services (DHS) proposal decreases the number of residents qualified to use Medicaid, while increasing spending on the benefits of those who remain. Molokai health care providers are concerned about how the changes will affect residents.

DHS announced last week they are decreasing the eligibility based on the federal poverty level (FPL), to help curb spending woes. Currently, applicants that have an income within 200 percent of FPL are qualified – for example, a family of four would be Medicaid-covered if they have a maximum yearly income of $51,420, according to the Foundation for Health Coverage Education.

The new Medicaid proposals, tentatively set to begin Jan. 2, 2012, will affect Quest-Ace and Quest-Net users – specific packages under Hawaii’s Medicaid system. The proposals will reduce the eligibility to 133 percent – meaning a family of four would need to survive on $34,194 or less each year to quality. Families making in the $40,000 range will no longer qualify for Medicaid. Those in the proposed gap will be automatically dis-enrolled when the changes take place.

“We’re worried about our patients,” said Desiree Puhi, executive director of the Molokai Community Health Center (MCHC). “What’s going to happen to [those in] these gaps, and how do we educate the community?”

Medicaid is a state health insurance program primarily serving pregnant women, children under 19, adults over 65, and those disabled or in need of nursing home care. The program is also open to healthy adults.

Talking Numbers
The changes come as the state continues to try and tighten its budget. The Medicaid program had a 2011 fiscal year budget of $606 million. The projected budget for 2013 is $800 million.

However, the proposed changes save the state a projected $150 million by reducing the number of participants, according to DHS Director Patricia McManaman.

DHS officials at a conference last week said this would affect around 4,500 people currently enrolled in Medicaid, which currently serves 271,000 people, according to DHS Med-Quest Administrator, Dr. Kenny Fink. Enrollment has increased 26 percent since June 2008.

Zessica Apiki, controller at Molokai General Hospital (MGH), said at least a third of their patients receive some sort of assistance from Medicaid, while Puhi estimated about half of MCHC’s patients are enrolled.

Fink also announced the state legislature passed a “fair share” initiative, allowing DHS to partner with the federal government for funds for health insurance. The state will put in $3 million, combined with the federal $27 million over the next six years, to upgrade the current system, which has not been updated in 23 years. Officials said this would speed up the process time and reduce the risk of fraud.

DHS also plans to implement an electronic medical records system. The department received $630,000 from the feds, and with the state’s $70,000 for the technology system statewide. Medical professionals could be awarded up to $64,000 a year, and hospitals $2 million.

Changes for Molokai
While the changes in eligibility will affect some residents who may qualify for Medicaid in the future, those that remain enrolled will also see some changes in their benefits.

The standardized benefits package will include dialysis, cancer treatment, and organ transplantation, lab tests, prescriptions, family planning, diabetes treatment, vaccines, emergency medical and dental, and limited non-emergency transportation. However, the new package will reduce the annual number of inpatient and outpatient visits by half, and cut behavioral health visits from 30 to six.

Apiki said the hospital is more concerned that residents realize how healthcare is changing. Fink said DHS’ proposed changes align with the federal expansion under the Affordable Care Act of 2014.

“If we had to look at that target or population, generally, Quest-Ace [users] are a healthier population – young single adults,” Apiki said. “They are by and large not the biggest users of ER facilities.”

Puhi, however, is worried that those dis-enrolled from Medicaid, lacking preventative care, will frequent the ER more. MGH has the only emergency facilities on the island.

“If [the patient is] only allowed 20 outpatient days, and they’re chronically ill, theoretically they’ll end up in the hospital…and cost everyone a lot more money,” she said. “[The plan is] short sighted – we need preventative care, to keep [people] out of the hospital.”

Dr. Dan McGuire, a private physician on Molokai, said that 20 visits a year will affect some of his Medicaid patients whom he sees every week.

“Theoretically, they’ll not be able to come,” McGuire said. “But I don’t care” – he said he’ll see them anyway.

Puhi said it is important for those currently on Medicaid to follow up with their paperwork, and make sure they stay enrolled if still qualified – under the new system, patients will no longer be automatically renewed every year.

“Statewide we’re all very worried,” she said. “The problem is the need is still there, but the care is not going to be provided or subsidized. We’re just figuring out how we go forward.”

The proposal will be sent to the Centers for Medicare & Medicaid Services (CMS) on May 19, said Joe Perez, communications specialist for DHS, for approval. He added that CMS is aware of the changes and will most likely approve them.

Medicaid In Brief
•    Benefit packages in Hawaii in three categories: Quest, Quest-Net and Quest-Ace
•    State contracts private insurer Ohana Care and nonprofit Aloha Care for Medicaid coverage – Molokai recipients only given Aloha Care
•    Not to be confused with Medicaid, Medicare is a federal insurance program, serving mainly the elderly and those on Social Security