New cuts to health services for the poor take hold in October, with the elimination of eye exams and glasses for adults on Medicaid.
Medicaid recipients are receiving notices about reductions, eliminations or other changes to an array of health services in the next few months. The $354 million Medicaid cut in the state budget includes limits and other changes to services totaling $16.5 million.
In addition to getting rid of routine adult eye care and glasses, the state plans to limit payments for deep cleaning dental treatments for people who have gum disease to once every two years from once a year. Outpatient physical therapy, occupational therapy and speech therapy for adults will be limited to three visits a year.
The Medicaid service reductions were included in Gov. Bev Perdue's proposed budget and adopted by the legislature. More health care limits may come as the state Medicaid office looks for more savings in the program.
Lanier Cansler, state secretary of health and human services, said the department looked for the least-damaging options for cuts.
"It's obviously a consideration and a concern," he said. "When we have to control the Medicaid budget, we try to do the things that have the least damage on health. It's tough decisions. The governor doesn't like them, we don't like them."
The department will likely need more service cuts to hit its budget targets and is formally gathering suggestions on ways to extract another $32 million to $118 million in state costs from the government health insurance program.
The state and federal governments pay for Medicaid. For every $1 the state spends, the federal government spends $2, meaning that the state will spend about $1 billion less on Medicaid this year than last year.
Residents are just beginning to see the impact, said Adam Searing, director of the N.C. Health Access Coalition.
"To take away people's grandparents' eyeglasses, why would you want to do that?" he asked.
"Whether you're poor or rich, you need to have eyeglasses, you need to be able to see the physical therapist if you're injured, you need to have your teeth cleaned. Just because you make less money than someone who is wealthier doesn't mean you don't need those things," he said.
The state needs permission from the federal government to eliminate the adult eye care and make other Medicaid changes. Dr. Randall Best, the state Medicaid office's medical director, said he does not anticipate a problem receiving federal approval by October because it's not unusual for states to not cover routine eye care.
Exams covered for some
Adults who have eye problems related to underlying medical conditions such as diabetes will still have their exams covered, he said. The restriction is meant to eliminate coverage for people who see eye doctors simply because they are near- or far-sighted.
Jimmy Gay of Jacksonville was concerned when he received a notice of Medicaid eliminating eye exams because it did not say that people like him with underlying medical conditions were excluded from the restriction. Gay, 55, said he has diabetes and a cataract in one eye. Cataracts and glaucoma, conditions that could lead to blindness, are associated with diabetes.
He was relieved to learn that people with diabetes could still get their eyes checked, but he worries that other people with medical conditions that eye doctors could catch will go undiagnosed.
"It's going to cause people not to get an eye exam for any reason," he said.
Rep. Nelson Dollar, a Cary Republican who worked on the Medicaid budget, said the legislature went along with DHHS suggestions on service cuts. When it came to limiting services, legislators and state administrators wanted to consider only items that would have the least potential for harming health so people would not end up seeking expensive emergency treatment for unattended illnesses.
Most of the Medicaid budget cuts came from reducing provider rates and looking for greater efficiencies, he said.
"We really minimized the impact, the overall impact, to Medicaid patients in the state of North Carolina," Dollar said. "The state of North Carolina still has today, as it did two months ago, the most generous package of Medicaid services out there."
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