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MEDIA ADVISORY

VIEWS: 12 PAGES: 14

									                                     Medicaid Watch: State Medicaid and Health Cuts & Expansions
                                    Dec. 31, 2010; See pp 13-14 for updated sources & resources on state health programs
                                                               National Snapshot Summary
    1901 18th St. NW (3rd Fl.)
                                     States made or are considering cuts or expansions in AL, AZ, AR, CA, CO,
     Washington, DC 20009
                                     CT, DC, FL,GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MI, MS, MN,
    Chief Executive Officer:         MT, NV, NJ, NM, NY, NC, OK, OR, SC, TN, TX, UT, VA, WA, WI & WY
          William E. Arnold          Almost all states already pay far-too-low fees to MDs, DDSs, hospitals &
                                     nursing homes and now almost all states are lowering those rates even more.
         Phone: (202) 290-2019       Some states have monthly numerical limits on Medicaid Rx’s—with very strict
             Fax: (202) 506-6504
          Web: www.tiicann.org       & low monthly caps in AL, AR, GA, KY, LA, MS, OK, SC, TN, TX & WV.
      Email: weaids@tiicann.org      More & more states deny adults non-emergency dental care & even dentures.
                                     Nearly 5,000 are ADAP waiting lists in AR, FL, GA, IA, LA, MT, NC, OH,
          Board of Directors
                                     SC, UT & VA; other states have made other cuts, or are likely to do so soon
                                     State Pharm. Asst. Progs. (SPAPs) in AK, IN, NY, PA, SC & WI exclude the
                Jeff Bloom           disabled; and HI, IL, MD, MO, MT & RI give the disabled lesser coverage
                Eric Camp            15 of 35 pre-health reform risk pools do not discount premiums for the poor
Donna Christensen MD MOC
              Jeff Coudriet        Alabama--has no spend down, an aged/disabled level of $674 (the SSI rate), a parent level
  Wayne A. Duffus MD PhD           of 11%/ 24% if wkg (‗10) & an ADAP level of 250%; covers 12 MD visits & hosp days/yr
       Richard Fortenbery          & only 5 brand name Rx‘s/mo but has no MSP asset tests Medicaid‘s 2011 shortfall is $64
        Thomas J. Fussaro          million. Ex-Gov. Riley (R) & the old legislature (D) cut HIV care $2 million but it
            Kathie M. Hiers        overrode his veto to raise CHIP‘s 200% level to 300%. The risk pool once planned low
     Maurice Hinchey MOC           income premium discounts but has no Medicare supplement. 2,500 are on the HCB waiver
          Gary R. Rose, JD         waiting list. Gov Bentley & the new legislature (both now R) favor deep health cuts.
   MikeLynn Salthouse RN
    Michael G. Sension MD          Alaska---this Title XVI state has no spend down; an aged/disabled level of $1,252/mo (its
        Katherine C. Stuart        SSI/SSP rate), a parent level of 77/81% if wkg (‗10), a 300% ADAP level, a risk pool with
        Michael J. Sullivan        a Medicare supplement but no low income premium discount & a token SPAP for those
              Valerie Volpe        under 175% that excludes the disabled. In spite of a $60 million 2011 deficit, Gov. Parnell
            Krista L. Wood         (R) & the legislature (R House; tied Senate) raised the 175% CHIP level to 200%.

                                   Arizona--covers parents & childless--even non-disabled--adults under100%/106% if wkg.
                                   The CHIP level is 200% & ADAP‘s is 300%.The legislature (R) killed a program covering
                                   the disabled during the 2 yr Medicare wait, cut MD fees & personal care funds but gave up
                                   up on dropping 310,000 clients or killing CHIP. With a budget short billions, Gov Brewer
                                   (R) cut ADAP‘s formulary (and may start a waiting list), mental health funds & home
                                    care, ended hospice & non-emergency transportation; and kept a CHIP freeze that‘s cut
                                    enrollment from 45,800 to 33,700 since 1/10, with a waiting list of 40,000. She ended
                                    adult coverage of physicals, podiatry, most dentistry, dentures, transplants (at least 2 pa-
                                    tients died so far), medical equip, insulin pumps, hearings aids, cochlear implants, insulin
                                    pumps, hearing aids, cochlear implants & computerized lower limb & joint prostheses.


  Thomas P. McCormack
  Editor, MEDICAID WATCH
   MedicaidWatch - supported by unrestricted educational grants from GlaxoSmithKlien, Abbott Laboratories, Amgen, Gilead
                 Sciences, Merck & Co., Bristol Myers Squibb, Boehringer Ingelheim & Tibotec Therpeutics
Arkansas—has an aged/disabled level of $674 (the SSI rate), a parent level of 13%/17% if wkg (‘10), a monthly
numerical Rx limit & an insurance subsidy for workers below 200% in participating small firms. Gov. Beebe & the
legislature (both D) covered adult dentistry & passed an unfunded bill to raise CHIP‘s 200% level to 250%. The risk pool
bans Medicare patients but plans to get funding for low income premium discounts. Beebe may cct the number of covered
MD visits & Rx‘s and ADAP‘s formulary & its income level from 500 to 200% and started an ADAP waiting list of 9.

California-- The state covers the aged/disabled under 100% (with a $230, not just a $20, disregard), parents below 100%/
106% wkg & prostate cancer patients under 200%. ADAP‘s level is 400% & CHIP‘s is 250%. With a $19 billion deficit,
ex-Gov. Schwarzenegger (R) & the legislature (D) raised premiums; capped child dental care at $1,500-$1,800/yr;
dropped adult dental, podiatry & psychiatric benefits; ended non-emergency care for legal aliens; and cut provider fees &
the HIV budget (with $12 million from ADAP---but most of the latter was at least temporarily restored). A $2.75 billion
MediCal cut dropped 3 million adults. He denied ADAP to county jail inmates & proposed ending some parents‘ eligib-
ility, home health care & personal aides for the disabled, low income clinic funding, adult day health care, limiting non-
―life-saving‖ Rx‘s to 6/mo & MD visits to 6/yr and imposing $50 ER co-pays,.MD & hospital fee cuts; ending adult day
care & optometry; & a 20% personal aide pay cut. LA Co‘s Health Dept has a $389-$429 million 2011 shortfall that could
cut clinic patients served by 1/3 to 1/2. Courts barred dropping adult podiatry, chiropractic & dental services—at least un-
til CMS approves. The new budget cuts HIV care $52 million, but Gov Brown (D) favors protecting the health safety net.

Colorado---has no spend down. The level for those over 60 is $699 (their SSI+ SSP rate), but it‘s only $674/mo (the SSI-
only rate) for younger disabled. ADAP ‗s level is 400%. The risk pool has low income premium discounts for those below
$50,000 & Medicare supplements. Ex-Gov Ritter (D) began a formulary, made health plans cover PTSD, anorexia, sub-
stance abuse & colorectal screening, proposed de-funding 79 to 626 health facility slots & reducing low income clinic
funding, and cut ADAP‘s formulary. Medicaid‘s caseload is up 200,00 since 2001, but he & the old legislature (D) passed
a hospital tax to raise $600 million for Medicaid, CHIP & the state indigent health program; boost hospital rates & funds
for uncompensated care; and cover 100,000 more persons by raising all adult levels to 100% (now in effect for parents &
by 2012 also for the childless, even if not disabled) with newly-offered US health reform matching; applied the mini-
COBRA law to small firms; raised CHIP‘s level from 205 to 250% & widened its psychiatric care; will offer Medicaid to
the working disabled earning up to $83,000/yr (with premiums subsidized up to 450% of the FPL) starting 7/1/11, began a
SPAP for HIV clients; covered legal aliens; set a 300% level for nursing home & HCB waiver care (with no cap on
patient numbers, and with related ―CAHI‖ [www.coahi.org] & self-directed personal aide programs). Yet some parents &
advocates for disabled children say the state 300% level is too low for the FOA coverage option (which federal law says
can be set up to 500%), even though US law does cap states‘ Katie Becket & HCB waivers at 300%) to reach enough
such children; that their Mediicaid premiums are too high & that the state still rations how many cases can be covered.
The state let HMOs sell cheap policies to the uninsured--but did cut funds for DD & disabled clients‘ employment, trans-
portation & personal aide pay and may have to start an ADAP waiting list. Gov Hickenlooper (D) & the Senate (still D)
favor health coverage expansion, but the narrow (by 1 vote) new GOP House majority may well impede the expansions.
Connecticut—is a 209(b) state with 2-zone aged/disabled levels ($786.22 & $894.61, its SSI/SSP rates for those with the
highest allowed shelter costs, including the value of a $278 disregard). Its parent level is 185%/191% if wkg; ADAP‘s is
400%; CHIP‘s is 300%; and its risk pool has a low income premium discount for those under 200% & a Medicare supple-
ment. Ex-Gov. Rell (R) ended the SPAP‘s coverage of Pt D non-formulary Rx‘s (but it still covers Pt D-excluded Rx‘s);
the SPAP co-pay remains $16.25 & it has no MSP asset test (income levels are $25,100 for 1 & $33,800 for 2). She
limited adult chiropractor, naturopath, psychologist and occu, phys & speech therapy coverage to clinics; but extended
hospice care to all Medicaid patients. She moved to cut HIV services $2.7 million, delay starting an HIV HCB waiver,
raise CHIP & Medicaid cost-sharing and drop most adult dental, eyeglass, OTC Rx &, legal alien coverage. The legisla-
ture (D) covered the working disabled. Rell wanted to force patients back into HMOs to fund her skimpy, subsidized
insurance plan for those under 300%. With premiums up 72% since 1/10, it has big co-pays, limited psychiatric care, low
Rx & medical equip cost caps/yr, a $100,000/yr total care cap & a $1 million lifetime cap--and may have to close enroll-
ment. The state got CMS to agree to new US matching to widen Medicaid to childless non-disabled adults under 56% who
were eligible for state General Medical Assistance (even keeping its $150/mo earnings disregard), extended COBRA
coverage to 30 mos, and raised QMB‘s income level to 207%+, SLMB‘s to 227%+ & QI‘s to 242%+ (giving most SPAP
clients full Pt D Extra Help too). The 2011 deficit is $263 million. Gov. Malloy (D) favors health coverage expansion.


                     The Ryan White CARE Act, Title II, Community AIDS National Network, Inc.                              2
Delaware---has no spend down; covers all adults under 100% (121% for wkg parents & 110% for wkg childless, non-dis-
abled adults); the ADAP level is 500% and those for CHIP & the SPAP are 200%. Gov Markell & the legislature (both D)
operate a state-funded cancer assistance program for those under 650% & state-funded medical assistance (more limited
than Medicaid) for others under 200%, covered the working disabled and may let over-income children buy into CHIP.

District of Columbia---has income levels of 200%/207% wkg for parents, 100% for aged & disabled, 300% for CHIP &
400% for ADAP. DC‘s llocal, non-federal medical assistance covers others under 200%/211% wkg. Ex-Mayor Fenty &
the Council (both D) covered adult dentistry; boosted the aged/disabled asset level $2,000, raised QMB‘s income level to
300% & dropped its asset test (entitling many DC Medicare patients to Pt D‘s full Extra Help). He proposed replacing
public mental health clinic care with private contractor services & cutting funds for low income clinics and revoked DC‘s
just-raised MD fees for QMB clients & cut home care funding. DC is widening Medicaid to childless, non-disabled adults
who‘ve been on non-federal medical assistance with newly-offered US health reform matching & is keeping the safety
net, debt-ridden United Med Ctr (formerly Greater SE Hosp) open after buying it at public auction. CMS says DC--now
facing a $300 million 2 yr deficit--owes $58 million for over-claimed 2004-05 matching, which Mayor Gray (D) contests

Florida---The legislature (R) got a waiver to move patients (a court order does let them opt out) into contract managed
care; but the state has so far done so in only 5 counties & a state request to extend the waiver is now being questioned by
CMS—especially since it still hasn‘t been expanded to more counties, much less statewide.Yet GOP legislators & Gov.
Scott (R) still want to expand managed care, to cut MD fees and, above all, to realize more savings.The under-funded,
usually-closed pre-health reform, state-funded risk pool has a Medicare supplement but no low income premium discount.
The legislature cut the aged/disabled level from 88% to SSI‘s $674/mo rate, except for those in HCB waivers or in Medi-
care‘s 2 yr disabled waiting period. The parent level is 21%/53% wkg (‗10) & ADAP‘s 400% level was cut to 300%. The
state covers dentures (but little other adult dentistry) & hearing aids. Ex-Gov Crist (I) dropped coverage of Zyprexa & In-
vesa Sustena, wants to let children over its 200% level buy into CHIP & made private plans cover autism care, gutted the
insurance minimum benefits law & fostered cheap policies for the uninsured ( www.coverfloridahealthcare.com; its start-
up is delayed to 1/11 or later & its policies may not meet US health reform insurance rules without an HHS waiver). Blue
Cross & a local health dept. sponsor cheap ($105/mo for 1 person under 250%), barebones ―Miami-Dade Blue‖ policies
with no Rx brand name coverage. Crist dropped hospice & cut dialysis care; and slashed mental health & substance abuse
funds & MD fees. HCB & home care waiting lists are long, but to settle a suit the state is spending $27 million more on
HCB waivers. Crist raised cigarette taxes $1 to yield $1 billion (much for Medicaid), vetoed nursing home & DD care fee
cuts; and signed a bill to make insurers sell Medigap policies almost as fairly to the disabled as to the aged. Miami‘s Jack-
son Mem Hosp is closing 2 O/P clinics & 2 transplant units; ending dialysis care for 175 indigents (many of them illegal
aliens); and may close its North satellite branch hospital. ADAP cut its formulary & has a waiting list of 2,491---to which
350+ more will be added by the income level cut from 400 to 300%. The HIV insurance premium assistance program
level is still 400% (neither it nor ADAP have asset tests) yet it is short $1.5 million even after getting $1 million from
other HIV accounts--and has its own waiting list of 260+. Funding shortfalls forced Jacksonville to close 3 public clinics

Georgia---Its aged/disabled level is only $674/mo (the SSI rate), its parent level is 28%/50% if working (‗10), ADAP‘s is
300% & CHIP‘s is 235%. It has a monthly numerical limit on Rx‘s; dropped CHIP coverage of dental surgery & raised its
premiums; ended adult emergency dentistry & artificial limb benefits and nursing home spend downs and narrowed Katie
Beckett waiver admission rules. Ex-Gov. Perdue & the legislature (both R) herded patients into HMOs, but allow opt outs.
Provider fees are too low. Atlanta‘s Grady Hosp, once short $40+ million due to indigent care costs, closed its dialysis
center but arranged continued care for 38 indigent illegal alien patients) & 3 of its 9 O/P clinics and cut its free care level
from 250 to 125%. With 2011‘s $506 million Medicaid shortfall, Perdue dropped plans for provider fee raises & may cut
ADAP $1.2 million. He planned to sign a 1.45% hospital bed tax (proceeds would attract more US funds to raise hospital
fees), but MD & DDS fees will still be cut (again). He seeks higher insurance taxes & fines to meet health costs, closed a
mental hospital building, raised CHIP premiums, cut pregnancy & infant care funding; cut welare staffing, has an ADAP
waiting list of 845 & may privatize some mental health care. Gov Deal (R) favors even more extensive health cuts.

Guam—this territory‘s matching funds are capped by law far below what states get. Its local medically indigent program
(MIP) pays even less than Medicaid & has almost no private providers. Scanty funding for off-island specialty care & air
transport to it runs out quickly. Provider fees are too low & paid too late. Only 1 dentist takes Medicaid & CHIP patients

                     The Ryan White CARE Act, Title II, Community AIDS National Network, Inc.                                3
Hawaii—this 209(b) state gives limited Medicaid benefits to all adults below 200% (even the childless & non-disabled),
but only parents and the aged & disabled under 100% get full Medicaid. ADAP‘s level is 400%. The state covers the wkg
disabled. Ex-Gov. Lingle (R) & the legislature (D) raised CHIP‘s level to 300%, ended its premiums & let richer children
buy in. With an $86 million 2011 shortfall, she closed ADAP to those with CD4 counts over 350, began moving 37,000
aged & disabled into managed care, ended non-emergency adult dentistry & began planning unspecified benefit
eliminations & reductions for non-pregnant, non-disabled adults. Gov Abercrombie (D) favors health expansion, and will
try to avoid cuts, but the state faces massive 2011 & 2012 deficits.

Idaho---a Title XVI state, with no spend down, an aged/disabled level of $707 (the SSI/SSP rate), a parent level of 21%/
27% if wkg (‗10) & a 200% ADAP level. The legislature (R) raised the CHIP level from 150 to 185%; funds a pilot plan
for workers under 185% in participating small firms, covered the wkg disabled & sorted clients into 3 groups: Parents &
children; disabled & chronic cases; and the aged. Each may get differing benefits or more co-pays but also more preven-
tive care. Gov. Otter (R) covered adult dentistry but charges 4% of income premiums to Katie Becket cases. The 2011 de-
ficit is $86 million, so the state may charge all disabled children extra premiums, did cut hospital, MD, rehab facility &
DD agency fees (which a court then voided); slashed occu & speech therapy, mental health & autism care funding &, may
cap ADAP enrollment, The House voted to end the adult cystic fibrosis program & drop non-emergency transportation

Illinois---this 209(b) state‘s aged/disabled level is 100% (with a $25, not just a $20, disregard). Its main SPAP excludes
those disabled not yet on Medicare, who get only a very limited formulary from a 2nd SPAP. Both SPAPs‘ income levels
are $27,600 for 1, $36,635 for 2, etc. The legislature (D) raised the parent level to 185%, accepted a court order to raise
pediatric fees (yet other fees are too low & paid very late, with a $4 billion unpaid claims backlog), subsidizes insurance
for veterans left uncovered by VA cuts & raised CHIP‘s 200% level to 300%. The often-closed risk pool has a Medicare
supplement but no low income premium discount (but the new, separate US health reform-funded state risk pool‘s pre-
miums are reported to be as low as $200/mo). The state is forcing 40,000 aged & disabled into HMOs but raised the work-
ing disabled level to 350% & required that Medigap policies be sold as fairly to the disabled as to the aged. The U of Chi-
cago Med Ctr closed its women‘s & dental clinics & the U of IL at Chicago closed a clinic too. The state gave $640 mil-
lion to safety net hospitals, made hospitals give the uninsured discounts & imposed a hospital ―assessment fee‖ to raise e-
nough to attract $450 million more in US matching. With a $13+ billion deficit, the legislature gave Gov. Quinn (D) auth-
ority to cut the budget ($500 million in health & welfare cuts—including in community mental health--are expected). He
hopes to save $400 million more with case management for the aged & disabled (38,000 of them are already on HCB wait
lists) & funded ADAP enough to serve 4,500 more clients in 2010, but its 500% income level may have to be cut to 350%

Indiana---this 209(b) state‘s SPAP for those under 150% excludes the disabled & has a much-stricter-than-SSI ―209(b)‖
Medicaid disability rule (one must be fatally or incurably ill). The aged/disabled level is $674 (the SSI rate) & the regular
Medicaid parent level is 19%/25% wkg (‗10). Gov. Daniels & the old legislature (both R) raised CHIP premiums The risk
pool has a Medicare supplement & a low income premium discount. The ACLU sued to void a once-each-6-yrs denture
replacement & re-lining limit. The House (then D, but now R again) opposed Daniels‘ troubled, now-canceled eligibility
privatization contract, while a class action suit sought to counter contractor eligibility failings. The ADAP (with a 300%
level) may have to start a waiting list and 21,000+ DD clients are already on a HCB waiver waiting list. The state raised
CHIP‘s level from 200 to 300%. A waiver subsidizes coverage for parents below 200%--and even has up to 42,000 slots
for the childless, non-disabled under 65 (but 52,000+ of them were already on its waiting list when Daniels closed
enrollment). Although Daniels‘ opposed the federal health reform bill, he now seeks to extend the waiver & then also use
newly-available US health reform matching to implement required coverage of all non-aged adults under 133% by—or
even before--2014. The waiver coverage is via HMOs & offers preventive care, few co-pays; yet no dental or vision care
—and patients must put 2%-4% of income into HSAs, pay too-costly premiums & meet $1100+/yr in cost-sharing. See
―Healthy IN..‖ at www.kff.org. Daniels plans to cut provider fees 5%. The state Supreme Ct rejected an ACLU class ac-
tion suit to make the state more proactively consider other possible impairments in Medicaid disability eligibility deter-
minations. The state eliminated or limited adult dental, vision, chiropractic & podiatry costs to cut the Medicaid budget.

Iowa--A waiver covers both I/P & O/P care and Rx‘s—at first, it could only be at 2 safety net hospitals in Des Moines &
Iowa City---for non-Medicare adults (even if childless & non-disabled) under 200%/250% if working,. But the state later

                     The Ryan White CARE Act, Title II, Community AIDS National Network, Inc.                               4
got CMS approval to expand the waiver to let patients get care at any low income clinic in the state and (at least) emer-
gency care at any hospital in Iowa. The aged/disabled level is $674/mo (the SSI rate), the parent level is 28%/ 83% if
working (‗10) & ADAP‘s is 200%. The risk pool has a Medicare supplement but no low income premium discount. Med-
caid faces a $600 million shortfall. Ex-Gov. Culver & the old legislature (both D) covered disabled children under 300%
via the FOA, raised the CHIP level from 200 to 300% & let children without dental coverage buy into CHIP dental
benefits. The hospitals are proposing a plan to tax themselves $40 million to attract added US matching funds to raise
their rates & fund other rising Medicaid costs. ADAP program costs were capped on 9/15 & there‘d briefly been a waiting
list. Gov Branstad & the new House majority (both R) likely favor Medicaid cuts, but the Senate is still Democratic

Kansas---this Title XVI state has an aged/disabled level of $674/mo (the SSI rate), a parent level of 26%/32% wkg (‗10),
a 200% CHIP level & a 300% ADAP level. Its GOP legislature, covered the wkg disabled, offered state mini-COBRA
rights, raised CHIP‘s level to 250%--but wouldn‘t fund previously-authorized adult eligibility expansions, an adequate eli-
gibility staff budget or the additional workers needed to cut a backlog of 12,000 applications. There are 5,700 on waiting
lists for services for phys disabled & DD clients, yet it cut home care funding for the aged & disabled; put 6,000 more on
waiting lists for HCB & home care; cut MD fees & pay for disabled clients‘ caregivers by 10%, ended welfare for 1,500
awaiting SSA disability awards; denied dental care to poor women; raised CHIP premiums $10 to $20/mo; and froze ad-
mission to 3 overcrowded state mental hospitals. With a $41 million 2011 Medicaid & human services shortfall, ex- Gov.
Parkinson (D) sought to have case managers oversee psychiatric Rx therapy & proposed a 1 cent sales tax raise--while the
hospitals favor a tobacco tax boost & the nursing homes offered to tax themselves, with each of those 2 taxes‘ proceeds to
then be used to attract more US matching to raise both those providers‘ respective rates The 3 taxes, if passed, could
prevent more cuts from being considered--such as imposing more pre-authorization barriers, co-pays for medically
unnecessary ER visits & cutting state DD facility admissions. Gov Brownback (R) favors even more health cuts

Kentucky--- has an aged/disabled level of $674/mo (the SSI rate), a parent level of 36%/62% if working (‗10), a 200%
CHIP level & a 300% ADAP level. The legislature (R Sen.; D House) dropped tough, yet unworkable, nursing home &
HCB medical admission rules; capped Rx‘s at 4/mo, limited occu, phys & speech therapy, x-rays & MRIs; raised co-pays;
and divided Medicaid‘s patients into 4 groups that can get different benefits: healthy adults; children; aged & disabled;
and MR & DD patients. Gov. Brashear (D) faces an impending Medicaid/CHIP shortfall of up to $500 million. He says
he‘ll save $108 million in 2010-11 with more efficiencies & an anti-smoking benefit. His Medicaid Cost Control commit-
tee offered few, real solutions—but Brashear did demand reforms in the L‘ville-area Medicaid PPO‘s management. He
enrolled 22,000 more children in CHIP & dropped its $20/mo premium. By 9/10 ADAP was able to cover the 227 clients
on its waiting list using alternate funding sources & making economies, but the co-pays & formulary cuts are still in place

Louisiana---has an aged/disabled level of $674/mo (the SSI rate), a parent level of 11%/25% wkg (‗10) & a 300% ADAP
level. The legislature (newly R-House; nominally D-Sen) voted to raise the CHIP 250% level to 300% but can‘t afford to.
Gov. Jindal (R) covered the wkg disabled, got CMS to agree to a state refund of only $266 million for past overpayments.
When a $30 million /yr US primary clinic grant wasn‘t renewed, he found other funds to continue it; and CMS even let
the state spend $97.3 million in US Medicaid hospital funds on primary care clinics. The state plans to cut $268 million by
cutting covered Rx‘s from 8 to 5 /mo (unless more are ―medically justified‖) and slashing MD & hospital rates & funds
for --and privatizing--community services & HCB waiver care for aged, CMI, DD & physi disabled clients. Jindal delayed
& may drop plans to move patients into capitated PPOs & HMOs which providers & advocates oppose. US matching falls
$700 million in 2011, 2012‘s deficit is $1.5 billion & he plans a $50 million+ cut in next year‘s Medicaid budget. FEMA
will pay $478 million to rebuild the N. O. Charity Hosp, & the state will add $300 million. But it also must find $70-$100
million/yr more for operating costs—although it even lacks enough funds to run 4 to 6 LSU & Charity Hospitals. ADAP‘s
$11.7 million shortfall required shifting $2 million from other HIV accounts to it---but there‘s still a waiting list of 532.

Maine—Ex-Gov. Baldacci & the old legislature (both D) set these income levels: subsidized insurance, 300% (up to $8
million more in premium subsidies were made available even to part-timers); the aged & disabled, 100% (with a $75, not
just a $20, disregard for both Medicaid & the MSPs); childless, non-disabled adults, 100% (via a waiver that‘s now taking
up to 2,000 new patients); parents, 200%/206% wkg; ADAP, 500%; CHIP, 200%; the SPAP, $1,604/mo for 1 & $2,159/
mo for 2; and 250% for O/P-only waiver care for HIV+ (even ―pre-disabled‖) patients. There‘s no risk pool. Baldacci fav-
ored an employer play or pay rule, reforming hospital funding & reinsurance plans. Adults get dentures but little other

                     The Ryan White CARE Act, Title II, Community AIDS National Network, Inc.                              5
dental care. There are no MSP asset tests & QMB‘s income level is 150%, SLMB‘s is 170% & QI‘s is 185%. With a $100
million 2011 deficit, the state raised cost-sharing for those over 150%, cut podiatry care & provider fees & may have to
start an ADAP waiting list Although state health offcials released a model planning document for state-level implemen-
tation of the US health reforms,.Gov LePage (R) & the new legislature (both Houses are now R) favor health cuts instead.

Maryland---has an aged/disabled level of only $674/mo (the SSI rate), a 300% CHIP level & a 500% ADAP level. An
appeals court upheld an AARP/Legal Aid suit to widen the state‘s too-strict nursing home, HCB waiver & at-home care
medical qualification & appeal rules. A waiver merged the main SPAP & a state low income O/P clinic program into one
O/P-only primary clinic care & Rx program for any non-Medicare adults (even if childless & non-disabled) under 116%.
A state-sponsored, Blue Cross-run 2nd SPAP (with a 300% level) covers some Pt D donut hole & premium costs, but
seems to exclude the disabled. A child‘s untreated tooth infection killed him, so an indigent child clinic was started at the
state dental school. The risk pool has low income premium discounts for those under 200%, but no Medicare supplement.
Gov O‘Malley & the legislature (both D) covered the wkg disabled, raised the parent level to 116% for full Medicaid &
subsidize insurance for some low paid small firm workers. He cut Medicaid $82+ million, including nursing home, home
health aide, private RN & HMO fees & slashed hospital rates to 80% of private plans‘. A $389 million 2011 deficit at first
forced him to delay a 2nd expansion of full Medicaid to childless, non-disabled adults under 116%--but he later said he‘ll
now implement that with newly-available US health reform matching He again cut provider, HMO, HCB programs &
personal aide fees for the disabled & plans more cuts, including closing a mental hospital. He & the nursing homes hope
to more than make up a fee cut with later rate increases to be funded by a 2% tax they‘ll pay that will attract more Medi-
ciad matching. With a $1.2 billion 2012 deficit, he‘s considering a $150-$264 ―million ―assessment‖ on hospitals to at-
tract more US matching with which to raise their rates & meet other Medicaid costs. He‘s raising child dental fees, carv-
ing child dental care out of HMO contracts for direct state managing & made hospitals give free care to those under 150%

Massachusetts---Ex-Gov. Romney (R) & the legislature (D) expanded Medicaid; required everyone to have insurance;
subsidized it for those under 300%; boosted the CHIP level from 200 to 400%; raised the parent & childless disabled
Medicaid levels to 133% but kept the childless aged level at only 100%. The ADAP level is 488% & the SPAP‘s is 188%
(but up to 500% for Pt D patients). Gov. Patrick (D), with a $2.5 billion 2012 deficit, raised subsidized insurance, Medi-
caid & SPAP cost-sharing; proposed freezing MD & hospital fees; cut funds for substance abuse, tobacco cessation,
school RNs & birth control; restricted legal aliens to limited I/P hospital care & a contract PPO network (advocates say it
has too few providers); and proposed confining adult denture & root canal services to community health centers; raising
MD & Rx co-pays (even for generics); requiring prior approval of costly psychiatric Rx‘s; ending personal aide care for
those getting it under 15 hrs/wk; cutting hospital fees & covered inpatient days to 20; and requiring college students to be
insured. He seeks $331 million in US funds to prop up 7 safety net hospitals; Cambridge Hosp & Boston Med Ctr each
seek $90 million in state or US funds for budget shortfalls; and executives of St. Elizabeth & Carney hospitals are seeking
equity buyers/partners to deal with their shortfalls. The legislature is considering forcing aged dual eligibles into HMOs

Michigan---has an aged/disabled level of 100%, a parent level of 37%/64% wkg (‗10), a CHIP level of 200% & a 450%
ADAP level. It ended adult dental (after an untreated tooth infection killed a patient, a suit was filed to bar the cut), vision,
hearing aid, podiatry & chiropractic coverage & briefly closed--but has just re-opened--its O/P care-only waiver for child-
less, non-disabled adults under 35%/45% wkg. The legislature raised co-pays but boosted child wellness, dental & adult
preventive fees. The Flint, Lansing, Muskegon & Detroit-area counties offer coverage to those under 200% & Oakland
Co. may do so too. With a $480 million 2011-12 deficit & a ½ million more cases in 2009, the House (once D, but now R
again) & Senate (still R) later briefly ended adult vision care--and must make more cuts, or raise taxes, in 2011-12. The
legislature sent ex-Gov Granholm (D) a budget restoring adult dental, vision & podiatry (but not hearing aid or chiroprac-
tic) services; avoids MD, hospital & mental health cuts (the latter was cut only $1 million) Advocates are demanding &
may sue to get more autism coverage in Medicaid & private plans. Gov Snyder‘s (R) plans aren‘t yet detailed.

Minnesota---this 209(b) state has an aged/disabled level of 100%, a regular, full Medicaid parent level of 215%/ 219% if
wkg (‗10), a CHIP level of 275%, an ADAP level of 300% & a risk pool with low income premium discounts for those
under 200% & a Medicare supplement. With a $6 billion 2011-12 deficit, ex-Gov. Pawlenty (R) raised premiums & co-
pays for Medicaid, CHIP & Minnesota Care (Medicaid waiver-funded, subsidized insurance for parents under 275% &
childless, non-disabled adults below 250%) and denied Medicaid & CHIP to legal aliens. He ended ADAP co-pays, cov-

                      The Ryan White CARE Act, Title II, Community AIDS National Network, Inc.                                 6
ered the wkg disabled, yet capped enrollment in HCB care. He tightened medical qualifications & cut paid hours for home
aides; reduced nursing home & HCB waiver care fees; raised some premiums; ended cover-age of occu & speech therapy
and audiology; and dropped adult dentistry. He & the legislature (then-D) compromised to preserve a cheaper, barebones
state Gen Med Asst (GMA) program for childless, vulnerable adults under 75% with stingy block grants totaling under ½
of GMA‘s earlier budget for provider hospitals to treat them. Hennepin Co. Med Ctr can‘t keep giving free care to other
counties‘ indigents & had to cut dental, mental health & HIV services. At first, no non-Twin Cities hospitals became pro-
viders in the new GMA plan since the grants are far below the cost of care. But, as authorized by the old legislature (D),
Gov Dayton (also D) plans to expand US-matched Medicaid to also cover GMA patients on Jan. 4, 2011, as now allowed
by the US health reform law, which the new GOP legislature opposes. Pawlenty tried to boost the appeal of the new, low
GMA grants to the hospitals--yet convinced only Hennepin & 3 others, but none outside the Twin Cities--by capping the
number of GMA patients each must take. Yet 18,000+ non-Twin Cities GMA patients until now have had no regular pro-
viders--and even those going to the 4 Twin Cities hospitals face long waits for primary care & longer waits for specialists

Mississippi---has no spend down. Gov. Barbour (R) cut the aged/disabled level from $1,000+ to $724/mo (with a $50, not
just $20,disregard) and there are no MSP asset tests. The parent level is 24%/ 44% wkg (‗10), CHIP‘s is 200% & ADAP‘s
is 400% (which may be cut to 200%). Only 2 brand Rx‘s & 3 generics/mo are covered (HIV patients get 5 brand Rx‘s).
Barbour cut phys, speech & occu therapy benefits & an in-person re-application rule limits enrollment; he & the Senate
(nominally D) won‘t drop it, except maybe for LTC, but the House (also nominally D) might. After securing new cigarette
& hospital taxes, Barbour first dropped, then again proposed MD, DDS, Rx, nursing home & hospital fee cuts, as well as
patient premiums & higher co-pays; cut mental health center subsidies, proposed closing 4 mental hospitals & 15 mental
crisis centers and opposes using state reserve funds & even enhanced US matching funds to bolster Medicaid (it is short
$34 million). Some disabled children‘s parents say the state has tightened Katie Becket waiver medical qualification rules

Missouri---is a 209(b) state. Its risk pool has no Medicare supplement but has a low income premium discount (and the
pool director has called for even more affordable premiums). The GOP legislature cut the aged/disabled level from 100 to
85%; ended medical assistance for those awaiting SSA disability awards; cut the parent level to 19%/ 25% if wkg (‗10);
ended adult dental coverage; raised CHIP premiums; denied CHIP to those whose job plans cost under 5% of income
(with exceptions); raised & more strictly enforced co-pays; but kept the ADAP & CHIP levels at 300% & raised the SPAP
(which covers the aged and disabled on Medicare) level to 150%. The SPAP law sunsets in 8/11, but Gov. Nixon (D) is
campaigning across the state to get the legislature (still R) to re-authorize it for 5 more years. Blue Cross & a foundation
subsidize insurance for KC-area families under $30,000. The state uses ―premium support‖ to pay clients‘ job plan prem-
iums rather than give them full secondary Medicaid; restored hospice & working disabled coverage (but the latter covers
only those with very low SSDI awards); offers birth control & screenings to women under 185%; restored adult vision
(except for the aged in nursing homes), hearing aid & podiatry benefits; and let the aged & disabled opt out of HMOs. A
court made the state widen notice & hearing rights before CHIP terminations & the state lets clinics enroll children. Nixon
asked the legislature to partially restore the former 100% parent level (only to 50%); cover all adult dental, hearing &
vision care; and liberalize CHIP premiums & coverage (but it rejected all 3 proposals). Caseload growth of 40,000+ since
1/09 then forced Nixon to drop plans to restore the 100% aged/disabled level & do more enrollment outreach (in fact, new
red tape instead now actually impedes enrollment). He sought cuts of $139 million in hospital rates & $32 million in MD
& DDS fees and in mental health & public clinic funding; and did cut the ADAP formulary. The legislature made private
plans cover some autism care. CMS said the state home health benefit is improperly limited only to homebound patients

Montana---has an aged/disabled level of $674/mo (the SSI rate), a parent level of 32%/56% if wkg (‗10), an ADAP level
of 330% & a risk pool with low income premium discounts for those under 150% & a Medicare supplement. The 2011
deficit is $201 million, so the state raised cost-sharing and cut LTC & hospice benefits and access—and also limited aged
& disabled MD visits to 10/yr. But Gov Schweitzer (D) & the legislature (with both Houses now R) ended a CHIP waiting
list (yet ADAP has one of 15); seek a waiver to cover more adults; raised the family asset level; set up a SPAP for Medic-
are patients under 200%; widened CHIP dental & preventive care; and made private plans offer vaccinations & well-child
care to age 7. A referendum raised the CHIP level (a 2nd time) to 250% but the children‘s enrollment pace has slowed.

Nebraska---is a Title XVI state with a one-house ―non-partisan‖, but conservative, legislature. Its aged/disabled level is
100%, its parent level is 47%/58% if wkg (‗10) & ADAP‘s is 200%. It ended Medicaid for many parents who chose to

                     The Ryan White CARE Act, Title II, Community AIDS National Network, Inc.                                7
leave welfare to work, yet the state Supreme Ct forbade denying Medicaid to those who fail to meet work mandates. The
risk pool has a Medicare supplement but no low income premium discount. Gov Heineman (R) covered Pt. D co-pays for
HCB & group home clients & raised CHIP‘s 185% level to 200%. With a $340 million 2012 deficit, the latest budget cuts
non-primary care Medicaid & CHIP reimbursement by $68 million and the state may limit dental care to $1,000/yr, hear-
ing aids to 1 per 4 yrs, eyeglasses to 1 per 2 yrs & adults to 12 chiropractic visits & 60 occu, speech & phys therapy ses-
sions/yr. The ADAP formulary was cut. When the state Medicaid program dropped pregnant aliens (even legal ones),
over 1,500 untreated cases were premature or stillborn--and costly. Even though the U of NE Med Ctr covered them in its
own indigent program, the legislature is now reconsidering that cut The state widened school-based health services.

Nevada---a Title XVI state with no spend down; its disabled level is $674/mo (the SSI rate), but the aged-only level is
$710.40 (their higher SSI/SSP rate); its parent level is 25%/88% wkg (‗10); its CHIP level is 200%; its ADAP level is
400%. It subsidizes insurance for parents under 200% working in participating small firms & covers the wkg disabled. Its
SPAP, with a 225% level, covers the disabled & even offers a vision benefit; but ex-Gov Gibbons (R) raised CHIP
premiums. With an $8.5 billion 2011 deficit the legislature ( still D) capped CHIP denistry at $600/yr; ended Medicaid
adult dental & vision care, CHIP orthodontia; tightened SNF, ICF, HCB waiver & home care medical eligibility rules; and
cut pregnancy coverage, hospital rates (closing the U of NV.at LV Hosp‘s dialysis & oncology units), HCB waiver fees &
attendant funds for the disabled; non-emergency transport, hospital neonatal, HCB & pediatric specialist fees. The LV-
area HIV budget was cut $1 million & many new indigents at low income clinics are causing big budget shortfalls. The
state set up a formulary of anti-psychotic, anticonvulsant & diabetic Rx‘s. Gov Sandoval (R) has already proposed a $200
million cut in the current budget & $500 million in the 2013-14 budget; ending the $53 million personal aide program for
the disabled, as well as a $104 million Rx benefits cut; nd reducuing O/P mental health services by $60 million..

New Hampshire---a 209(b) state; its risk pool has no Medicare supplement but has low income premium discounts for
those under 250%. Its aged/disabled level is $714 (the SSI/SSP rate, with a disregard of just $13, not $20/mo). The parent
level is 39%/49% wkg (‗10), and the CHIP & ADAP levels are 300%. It has a much-stricter-than-SSI ―209(b)‖ Medicaid
disability rule (inability to work for over 4 years) & doesn‘t cover hospices. Gov. Lynch (D) & the legislature (once brief-
ly D, but now R again) shifted LTC costs to counties, ended a DD care waiting list, let youths under age 26 buy into CHIP
& will make more cuts in hospital, MD, LTC & mental health fees (before the cuts, 2011-2‘s deficit was already $75 mil-
lion). US auditors want $35 million in overclaimed DSH funds back & 2010 Medicaid costs ran $43+ million over budget

New Jersey---has an aged/disabled level of 100%; a 500% ADAP level that Gov. Christie (R) partially cut, in effect, by
limiting the formulary for those over 300% & SPAP levels of $31,850 for 1 & $36,791 for 2. A waiver covers others (ev-
en childless & non-disabled adults) under 100%. Ex-Gov Corzine & the legislature (both D) raised MD fees & low in-
come clinic funding & the parent level to 200% & ended CHIP premiums for those under 200%. Christie roposed to lower
the parent level to 133%. One audit questioned $52 million in school health costs & a 2nd said hospital indigency prog-
rams fail to collect millions from other liable payers. A trial court barred an assisted living facility chain from refus-ing to
let residents stay on Medicaid when their own funds run out--but after some facilities tried to ev-ade the order (which was
upheld on appeal) by giving up their Medicaid provider licenses, the legislature is about to pass a bill requiring them to set
up escrow funds to pay for continued care of such residents--even if a facility closes down or goes bankrupt. With an $11
billion 2011-12 deficit, the state cut hospital charity & teaching, day health center & the SPAP & ADAP formularies &
raised SPAP co-pays. Christie seeks to drop adult aliens (even if legal) & township indig-ent care funding & close parent
enrollment, but the legislature (still D) made him drop plans to again raise SPAP co-pays & impose $310/yr deductibles--
yet he‘s still refusing US funding for female birth control, obstetrics & even for cervical & breast cancer screening

New Mexico—has no spend down, but has a risk pool with a Medicare supplement & low income premium discounts for
those under 400%. Its aged/disabled level is only $674/mo (the SSI rate), its parent level is 29%/67% if wkg (‗10), CHIP‘s
is 235% & ADAP‘s is 400%. A waiver—which is again closed to new individual applicants, but not to small employer
groups---heavily subsidizes insurance of any adult (even if childless or non-disabled) under 200%/250% if wkg. The state
still refuses to process disability-based Medicaid-only applications from those whose disability hasn‘t yet been approved
by SSA---contrary to what‘s long been a federal requirement---no matter how much they need medical care). Medicaid‘s
shortfall could be over $300 million by 1/11 (it was $40 million in mid-2010), so ex-Gov. Richardson (D) & the legisla-
ture (still D) dropped their eligibility expansion plans. The state may have to end adult dental, vision, hearing aid & hos-

                     The Ryan White CARE Act, Title II, Community AIDS National Network, Inc.                                  8
pice coverage; did slash phys, occu & speech therapy; cut mental health and substance abuse benefits & fees; and may
cut or drop some Rx coverage & HCB waiver care. Gov. Martinez‘ (R) expected health cuts are likely to be even deeper

New York---has a waiver for parents & couples (even if childless) under 150%, and childless (even non-disabled) single
adults under 65 below 100% (but the level‘s only $767/mo for childless aged). ADAP‘s level is 431%. The state subsid-
zes insurance for workers under 250%, but caps Rx‘s at $3,000/yr. The legislature (D House; R-Senate again, after briefly
being D) excludes the disabled from the SPAP (it has a 350%+ level); won‘t cover digital mammograms; raised Rx & MD
co-pays (but caps them at $200/yr); adopted a loose formulary; covers assisted living, chore aide & adult day care; its
counties pay ½ of state Medicaid costs (but their increases are capped at 3.5%/yr); lets providers deny services to those
who don‘t meet co-pays; funded HIV day health care; covered colon & prostate cancer patients & wkg disabled below
250%; required hospital discounts for those under 300% & banned taking debtors‘ homes; passed mental health parity; &
raised CHIP‘s level from 250 to 400%. With a $9 billion 2011-12 deficit, Gov. Paterson (D) made a $1 billion hospital &
nursing home fee cut; started a discount Rx plan for near-poor disabled; raised all Medicaid asset levels ($13,050 for 1,
$19,200 for 2, etc); ended MSP & SPAP asset tests; extended COBRA to 36 mos; proposed raising all adult levels to
200%; but sought to cut Medicaid & mental health $471 million more, force NYC HIV patients & all dual-eligibles into
HMOs, proposed a $65 million group home cut (yet a US judge then ordered that 4,300 mentally ill be moved into small-
er, better facilities) and signed a bill with $775 million in health cuts that requires saving $300 million more in each com-
ing year, pares $72 million from low income health programs; and makes big hospital fee cuts. Short $316 million, NYC‘s
public hospitals plan to cut child mental health & Rx benefits and close some clinics. NYC also proposed to end its school
dental program & cut its HIV services $17 million. The NYC Council de-funded a health insurance advocacy program &
its safety net St. Vincent Hosp closed. Paterson had earlier proposed cutting NYC public hospital subsidies $370 million
& Mayor Bloomberg proposes cutting up to 182 school nurse jobs. Gov-elect Cuomo‘s (D) health plans are still unclear

North Carolina---covers the wkg disabled, but allows only 8 Rx‘s a month (plus another 3 or more on an exception bas-
is).Its aged/disabled level is 100%; its parent level is 36%/49% if wkg (‗10) & its CHIP level is 200% (the deficit now
prevents raising it). The SPAP– which excluded the disabled & ceased operating in 3/10, but may be re-started after 1/11
—subsidized Pt. D premiums for those under 175% not on full Extra Help. The legislature (D through 2010, but R begin-
ing in 2011) created a nd SPAP for ADAP clients on Medicare under 175% but ineligible for Pt D full Extra Help & passed
limited mental health parity. It started a risk pool that excludes Medicare patients, requires pre-authorization & has a $250
co-pay for ―specialty‖ Rx‘s & a $100,000/yr out-of-pocket cap, but does have low income premium discounts. With a
$1.2 billion 2011 deficit Gov. Perdue (D) seeks $30 million in drug maker rebates by starting a preferred Rx list (she later
added some psychiatric Rx‘s to it); to propose closing 50 state mental hospital beds & cutting MD, hospital, personal aide
(plus limiting aide care to 18hrs/ wk), adult dentistry, maternal care outreach, mental health & community mental health
funding (the last by $210 million). The budget cut audiology, speech, phys & occu therapy & hospice funding and ADAP
by $3 million (causing a waiting list that briefly hit 811, a formulary cut limiting coverage to Tier 1 Rx‘s & a cut in
ADAP‘s income level from 300 to 125%). It ends a Medicaid HIV case manager program & coverage of community-
based rehab care and many child dental X-rays & sealants; limits breast surgery & coverage of diabetic items to 1 pro-
vider; and requires prior approval of X-rays, MRIs, MRAs, PET scans, ultrasounds & some EPSDT services. .2011‘s Me-
dicaid shortfall is $475 million. The state later found $14.1 million more for ADAP, cutting its waiting list to ―only‖ 87.

North Dakota---this 209(b) state has a risk pool with a Medicare supplement but no low income premium discount. Its
aged/disabled level is $750, its parent level is 34%/59% if wkg (‗10) but the ADAP level was cut from 400 to 300%. Ex-
Gov Hoeven (R) covered disabled children under 200% via the FOA, boosted the CHIP level to 150% & raised the medic-
ally needy/spend down level. But the legislature (R) refused to again raise CHIP‘s level (to 200% this time), cut ADAP‘s
formulary, capped its costs & enrollment and limited patient access to Fuzeon. Gov Dalrymple‘s (R) plans are unclear.

Ohio--this 209(b) state has a parent level of 90% and cut the ADAP level from 500 to 300% (disenrolling 257 clients,
triggering a waiting list of 380 and---only after public hearings are held & other administrative rules are met---possibly
denying eligibility to 861 of those with CD4 counts over 500 if their CD4 counts haven‘t ever fallen below 200). But then
ex-Gov. Strickland (D) shifted $12.8 million in new US Medicaid funds to ADAP to help ease--but not fully eliminate--
the cuts. Ohio slashed adult dental funds 50%, secondary fees for dual eligibles & medical assistance for those awaiting
SSA disability awards; moved most patients into HMOs (some with too few specialists); let providers turn away those

                     The Ryan White CARE Act, Title II, Community AIDS National Network, Inc.                              9
who don‘t meet co-pays; but did pass private plan mental health parity. Its aged/disabled level is still only $589/mo (the
US‘ very lowest). Strickland & the outgoing legislature (R-Sen; D- House) raised CHIP‘s 200% level to 300% (effective
only when a lawsuit is decided) & covered disabled children under 500% via the FOA. He got a waiver to cover assisted
living & lets over-income children buy into CHIP. He cut nursing home fees (but the legislature then partially restored the
fees & bolstered home care benefits); can‘t afford to cover adult digital hearing aids until 6/11; cut Rx fees & community
mental health funds; imposed Rx co-pays & a generics preference rule; delayed provider fee raises & fully restoring adult
dental benefits; and told nursing homes to themselves pay for their own patients‘ physical therapy, wheelchairs & medical
equip (which some homes can‘t afford or just won‘t cover, so some patients may not get needed care or equip). He moved
592 from waiting lists into HCB waiver care & signed bills imposing $718 million in fees on hospitals (with proceeds to
be used to attract more US matching, with which to then raise rates) & extending state mini-COBRA rights to small firms.
Gov- Kasich (R) and the new legislature (both Houses are now R) are likely to make even more Medicaid cuts

Oklahoma---this 209(b) state cut the aged/disabled level from 100% to $718 (the SSI/SSP rate). The parent level is
31%/47% wkg (‗10) & ADAP‘s is 200%. It ended its parents & children spend down, originally had a 3-Rx‘s/mo limit &
doesn‘t cover hospices. Ex-Gov. Henry (D) covered the breast/cervical cancer & wkg disabled groups and a waiver he got
subsidizes insurance for students, the unemployed & workers under 200% in participating small firms. Eligibility was lat-
er widened & the legislature (R) cut policy premiums--but also slashed benefits. It expanded Medicaid to cover assisted li-
ving; raised the CHIP level from 185 to 300%; encouraged HSAs in employer plans; and gutted the insurance minimum
benefits law. With a $26.6 million Medicaid cut, the state may drop pregnant women‘s dentistry, durable medical equip &
nebulizors and cut dialysis, diabetic supply, hospital, MD & nursing home fees; and raised some co-pays. It seeks to limit
ER visits to 3/yr; cut mental health care for 55,000 clients & closed 200 mental hospital beds; cut covered brand Rx‘s
from 3 to 2/mo; ended coverage of speech, occu, & phys therapy. Gov. Fallin (R) favors more health cuts.

Oregon---this Title XVI state‘s risk pool has no Medicare supplement but has low income premium discounts for those
under 185%. Income levels are $674/mo for aged & disabled (the SSI rate), a 32%/40% if wkg for parents (‗10), 185% for
an insurance subsidy for non-Medicare adults (with enrollment closed) & 200% for ADAP. An anti-tax referendum cut
eligibility & adult dentistry and ended adult vision care. With a $577 million 2011 deficit, the OR Health Plan expansion
waiver--with limited benefits for all non-Medicare adults under 100%--again froze enrollment. ADAP has cost-sharing,
with a waiting list & formulary cut also possible. Ex-Gov Kungoloski & the legislature (both then D) took the FOA option
& passed insurer & hospital taxes--later upheld in a referendum that also raised taxes on the rich--to cover 80,000 more
children (raising CHIP‘s level to 300%) 35,000 more adults & more home care--- yet later had to end home care for 100s
of cases. Gov Kitzhaber & the Senate (both D) favor expanded health care but the new House is tied between Ds & Rs

Pennsylvania---has an aged/disabled level of 100%, a parent level of 26%/34% if wkg (‗10), a CHIP level of 300% & an
ADAP level of 350%. It subsidizes an ―AdultBasic‖ insurance for non-Medicare adults under 208%/213% wkg (with no
mental health or Rx benefits; the 390,000 on its waiting list can buy similar private coverage for $600/mo; but Adult Ba-
sic‘s own increasingly costly clientele required imposing $20 MD visit co-pays & a $1,000/yr hospital care cap). Ex- Gov.
Rendell (D) covered the wkg disabled, raised the SPAP level (to $23,500 for 1 & $31,500 for 2, enough to cover 90,000
more aged, but it still doesn‘t cover the disabled) and applied 9 month state mini-COBRA rights to small firms. Gov Cor-
bett (R) & the new legislature (both Houses are now R) want more cuts (e.g., adult dentistry) & oppose any expansions.
(The outgoing House [D] had twice voted to widen AdultBasic to cover 85,000 more clients & add Rx & mental health
benefits.) The 2011-12 deficit is $4 billion. Phila city clinics began to charge $5-$20 a visit & close some sites. The state
had planned to offer $300/mo premium discounts to those under 200% in its US health reform-funded risk pool.

Puerto Rico----its matching rate is capped far below what states get. Its ADAP income level is 200%. ADAP reviews &
audits report inadequacies in care & fiscal irregularities. A key advocate has said there‘s a 526-person ADAP waiting list

Rhode Island---has these income levels: aged/disabled,100%, parents, 175%, CHIP, 250% & ADAP 400% (it was cut to
200%, briefly causing a waiting list of 12 until more funds were found). The state covers the wkg disabled & its limited
formulary SPAP covers the aged but only the disabled over age 55 (with levels of $37,167 for 1 & $42,476 for 2). Ex-Gov
Carcieri (R) required free & discount hospital care for those under 200% & 300% and banned taking debtors‘ homes.
Public Citizen says MD fees are the US‘ 3rd lowest. Big deficits ($107 million in 2011) moved him to get a waiver with

                     The Ryan White CARE Act, Title II, Community AIDS National Network, Inc.                             10
extra up-front US funds; in exchange it requires shifting 12% of nursing home cases to cheaper home care & caps future
US funds.The legislature (D) raised adult daycare co-pays; dropped Medicaid for legal alien children, 7,400 parents.&
dropped health insurance for childcare workers Incoming Gov. Chaffee (I) is excpected to have a moderate health policy.

South Carolina---has no spend down. Its aged/disabled level is 100% & its parent level is 48%/89% if wkg (‗10). It cut
its ADAP level to 300%. Its risk pool has a Medicare supplement but no low income premium discount. Ex-Gov
Sanford & the legislature (both R) limited Rx‘s to 4/mo & raised CHIP‘s level to 200% (but he then proposed closing
enrollment). The SPAP has a 200% level but excudes the disabled. With enrollment up 90,000 in 3 yrs, the state cut
mental health benefits, closed an HIV program to new clients & slashed home health, hospital & nursing home fees. Yet it
passed private plan mental health parity & a tobacco tax raise for Medicaid—which Sanford vetoed. It also ended SPAP
coverage of drugs not covered by Pt D, cut SPAP funds and ended state ADAP funding (dropping 200 patients) even with
a waiting list ialready at 314), cut home, personal aide & HCB care ( the last 3 face court challenges), reduced Rx cover-
age from 8 to 7/mo & de-funded cancer screening. Gov Haley (R) plans to end adult dental (even emergency pain relief
& extractions, their only current benefits), insulin pump, vision & hospice coverage; and cut occu & phys therapy sessions

South Dakota---has no spend down. Its aged/disabled level is $674/mo (the SSI rate), its parent level is 52% (‗10) &
ADAP‘s is 300%. Rejecting a call for expansion, Gov. Rounds & the legislature (both R) refused to raise the pregnant
women‘s & CHIP levels to 250% or provider fees and ended adult dental coverage.

Tennessee----Ex-Gov. Bredeson (D) & the legislature (R) set the aged/disabled level at $674/mo (the SSI rate), parents‘
at 70%/129% if wkg (‗10) & ADAP‘s at 300%. Except for the pregnant, children & HIV+ patients, MD visits were cut to
10/yr, hosp days to 20/yr & Rx‘s to 2 brand name drugs + 3 generics/mo, except for some grave conditions. There‘s a
250% CHIP level, a risk pool (with no Medicare supplement but with a premium discount for those below 250%), a SPAP
(with a waiting list & low benefits cap) covering up to 5 generics/mo for non-Medicare patients under 250% & subsidized
barebones insurance for non-Medicare adults under $55,000 (enrollment is closed). CHIP uses Medicaid Rx rules, but also
covers diabetic items & more psychiatric Rx‘s. Home care & medical equip benefits were cut. The state closed 600 mental
hosp beds, and made big mental health cuts & a $500 million hosp rate cut —causing shortfalls at Nashville Gen Hosp
(which then had to deny non-emergency care to indigent illegals) & Memphis Reg Med Ctr (but the latter then got a $30
million US/state grant). Bredeson deferred caps on MD visits, transport & transplant care, kept a $10,000/yr benefits cap;
curtailed occu, speech & phys therapy benefits; and capped X-ray & lab usage and ADAP costs. A court voided its 1987
order grandfathering-in 150,000 ex-SSI recipients to Medicaid (almost all of whom were then found ineligible under tod-
ay‘s regular rules); see ―Daniels Case‖ at www.tnjustice.org Gov Haslam (R) is expected to favor more Medicaid cuts.

Texas—has a risk pool with a Medicare supplement & but no low income premium discount .The aged/disabled level is
$674/mo (the SSI rate), the parent level is 12%/26% wkg (‗10) & the ADAP & CHIP levels are 200%. Gov. Perry & the
legislature (both R) dropped coverage of CHIP prostheses, physical therapy & private duty nursing; raised CHIP co-pays
& premiums; cut Medicaid home health; ended adult chiropractic & podiatry care; capped the number of Rx‘s covered
monthly, moved patients into HMOs; contracted-out eligibility work to what some say are sub par contractors--but
restored Medicaid mental health, vision & hearing aid coverage and CHIP mental health & dentistry (Medicaid covers
limited adult dentistry too); required some mental health parity in private plans; and set up a SPAP for HIV clients. A
non-profit agency (www.TexHealthCoalition.org) fosters subsidized cheap health plans for workers under 300% in small
firms in the Brazos Valley, Dallas, El Paso, Ft. Worth, Galveston & Houston areas. A court order to improve child health
& EPSDT requires higher MD & DDS fees (but budget shortages are now forcing cuts in all provider fees). The 2011-12
deficit is $25 bilion (due in part to 350,000 added Medicaid clients in 2009-10). The legislature cut the Children with
Special Health Needs program--plus a cystic fibrosis aid program for all ages--by $3.5 million (even with 950 children on
a waiting list); dropped funding for 13,000 HCB waiver slots & authorized cutting the ADAP income level from 200% to
125% if financially necessary. Gov. Perry & other GOP leaders are now toying with dropping out of Medicaid altogether.

Utah—is a Title XVI state with a risk pool that has a low income premium discount, but no Medicare supplement. Its
aged/disabled level is now 100%, its parent level is 38%/44% if wkg (‗10) & CHIP‘s is 200%. A waiver—now closed to
new enrollees--gives limited O/P care, with big co-pays, to non-Medicare adults (even if childless & non-disabled) under
150%. The legislature (R) stopped covering podiatry, audiology, speech therapy, chiropractic, outdoor wheelchairs and

                    The Ryan White CARE Act, Title II, Community AIDS National Network, Inc.                           11
adult eyeglasses & dentistry (one patient‘s untreated tooth infection spread to her brain & killed her); cut hospital & DDS
fees 25%; but subsidizes insurance for workers under 150% in participating small firms (see ―New CHIP /UPP Waiver..”
at www.healthpolicyproject.org) A legislative reform panel called for gutting the minimum benefits law & banning pre-
existing condition rules; and urging employers to offer HSAs instead of regular insurance--and the state let insurers sell
even-cheaper-than-COBRA, barebones policies. Gov. Herbert (R) restored dental care for children & pregnant women
and some phys & occu therapy. Yet he & the legislature cut DDS fees again (which CMS then disapproved); until recent-
ly had an ADAP waiting list of 143 and cut its formulary & income level (to 250%, disenrolling 89 clients); closed enroll-
ment in Gen. Asst. welfare for those awaiting SSA disability awards (which then impedes access to already-hard-to-get
Gen Medical Asst). They may cut the disabled level from 100 to 74%, school health funds & the pregnant women‘s asset
level & drop the spend down—but are considering a $23 million hospital tax to attract $50 million more in US matching.

Vermont—Its levels are: aged/disabled (2 zones) 101% & 110%; parents, 185%/191% if wkg; childless, non-disabled
adults, 150% /160% if wkg; CHIP, 300%; ADAP, 200% & the SPAP, 175%. There are no MSP asset tests. The state sub-
sidizes insurance for others under 300%. Dentures still aren‘t covered & there‘s a $495/yr dental care cost cap per adult
patient). A waiver, in return for more US funds, moves patients into HMOs & favors HCB care over nursing homes--but
also caps future US matching funds. The 2011 health & welfare shortfall is $53 million. Outgoing Gov Douglas (R) prom-
ised not to cut eligibility (and even signed a bill requiring more private insurance autism coverage), yet raised SPAP co-
pays & sought more client cost-sharing (but the Democratic legislature blocked CHIP premiums), a cap on allowed ER
visits and provider & druggist fee cuts. Incoming Gov. Shumlin (D) is expected to favor health coverage expansion.

Virginia---this 209(b) state‘s parent level is 23/29% if wkg (‗10), CHIP‘s is 200% & ADAP‘s is 400%. It covers the wkg
disabled & has a SPAP for HIV+ Pt. D patients under 300%. To cut a $4 billion deficit, Gov. McDonnell & the House
(both R) ignored less stringent Senate (D) proposals to slash provider fees & mental health & substance abuse community
care funding, lower the $2,200/mo HCB waiver income level to $1,685 (even with a HCB waiting list of 6,000); cut
CHIP‘s 200% level to 175% (which will turn away 28,000 children) and the 80% aged/disabled level to 75%. ADAP has
a $12.6 million shortfall that caused it to close enrollment and drop 760 patients (except pregnant women, children, those
with CD4 counts under 350 & those with an opportunistic infection history). The waiting list was already 57, but Gov.
McDonnell found enough funds to reduce it to ―only‖ 39.

Virgin Islands--its matching rate is far below what states get. Some say its ADAP (with a 400% level) has a waiting list.

Washington--its risk pool has a supplement open to some, but not all, Medicare patients & a low income premium
discount for those under 300%. Its aged/disabled level is $720 (the SSI/SSP rate), its parent level is 37%/74% if wkg (‗10)
but ADAP‘s 300% level was cut to 275%. Gov. Gregoire & the legislature (both D) passed mental health parity. Assisted
living facilities evicted over 75 clients due to low state fees. A $112.8 million health assistance budget cut forced her to
drop 21,000 undocumented alien children & propose dropping 27,000 others from CHIP (its income level had only recent-
y been raised from 250% to 300%). The state raised BasicHealth (its subsidized insurance for non-Medicare adults under
200%, with a waiting list of 100,000+) premiums & co-pays; cut General Medical Assistance (by $190 million, dropping
3,000+ patients), DSH payments & nursing home fees; and limited drug, DME, imaging, denture, diabetic supplies,
personal aide & home care hours, adult day care, maternity & infant case management & incontinence benefits and cut
druggist, pediatric MD, HMO & day health center fees. It may drop adult hearing aids, podiatry, vision care, dentistry,
colorectal cancer screening and---since a referendum to impose income taxes on the very rich failed at the polls, while the
voters instead even repealed some existing taxes---be forced to drop adult hospice care & Rx benefits. Yet the state may
let over-inome children buy into a CHIP-like plan. ADAP‘s formulary was cut, cost-sharing was imposed & Gregoire
proposed a 25% cut in other HIV care. The state had once sought insurer bids to offer a low-cost insurance & has begun
exploring using newly-available US health reform matching to fund the merger of the BasicHealth program into Medicaid

West Virginia---has an aged/disabled level of $674/mo (the SSI rate), a parent level of 17%/33% if wkg (‗10) & a 250%
ADAP level. It covers only 4 brand Rx‘s/mo (+6 generics). Its risk pool has no Medicare supplement but low income pre-
mium discounts have been authorized. It denies all adult dental care but extractions & emergencies a& didn‘t properly ad-
opt nursing home & HCB medical admission rules (which still impede access). Ex-Gov Manchin & the legislature (both
D) started an Rx aid plan for non-Medicare adults under 200%. CMS is trying, over state objections, to halt a waiver that

                     The Ryan White CARE Act, Title II, Community AIDS National Network, Inc.                            12
offers clients more mental health care & Rx‘s--but only if they sign ―personal responsibility‖ pledges. Manchin raised the
CHIP level to 250% but plans to herd the disabled into physical & mental health managed care and parents & children in-
to dental & mental health managed care that advocates say cuts access to care. Gov Tomblin‘s (D) health plans are unclear

Wisconsin---has an aged/disabled level of $757.78/mo (the SSI/SSP rate),a 300% ADAP level & a 240% SPAP (which
excludes the disabled) level. The risk pool has a Medicare supplement & premium discounts for those under $33,000 Ex-
Gov Doyle & the old legislature (both D) raised the CHIP (185 to 300%) & parent (185 to 200%) levels, made pri-vate
plans cover child hearing aids & cochlear implants & funded ―Basic Care‖ (with no brand Rx coverage) for up to 64,000
non-Medicare childless adults under 200%. Basic Care‘s caseload now exceeds funding capacity (plus 80,000 more on a
waiting list or with pending applications), so Doyle closed enrollment in it; but proposed a new, cheap, skimpi-er plan for
those on the waitng list (he was considering seeking now-available US health reform matching to merge both Basic Care
& the overflow plan into Medicaid). He sought a $900 million hospital tax to raise their rates by attracting more US
Medicaid matching. For 2011-12, the state needs $675 million more for health assistance & faces a $2.7 billion total
deficit—but Gov Walker & the new legislature (both R) aren‘t expected to protect Medicaid, much less expand coverage.

Wyoming--has no spend down, an aged/disabled level of $699 (the SSI/SSP rate), a parent level of 40%/52% if wkg (‗10)
& a 200% CHIP level. Its SPAP covers non-Medicare persons below 100%. The legislature (R) widened CHIP mental
health, vision & dental benefits. Outgoing Gov Freudenthal (D) added a risk pool low income premium discount for those
under 250% (it already had a Medicare supplement) & finalized plans with GOP legislators to offer subsidized limited,
preventive-oriented insurance for working adults under 200% by 1/11. Medicaid‗s 2010 costs rose $100 million--and its
next year‘s budget shortfall is $192 million--so the state plans to cut most provider fees $25.6 million, the DD & HCB
budget by $3.6 million (freezing-in a waiting list) & state dialysis aid by $250,000. ADAP‘s 332% income level was cut,
its enrollment was capped & it may again need a waiting list. Gov. Mead (R) is expected to cut Medicaid even more

SOURCES AND RESOURCES:

For the 48 states & DC, 2010’s federal poverty level (FPL) is $10,830/yr ($902.50/ mo) for one plus $3740 yr
($311.67/mo) more for each add’l person; see the Asst. Sec. for Planning & Evaluation pages at www.dhhs.gov for
prior years’ FPLs and AK’s & HI’s separate & higher FPLs. The 2011 SSI rates (not including state supplementary
payments, or SSPs) are the same as in 2009 & 2010: $674/mo for 1 & $1,011 for 2. Email sherry.barber@ssa.gov for
“State Asst. Programs for SSI Recips, 1/09”(the latest available issue) on state Medicaid eligibility rules for SSI &
SSP recipients, state supplementary payment (SSP) amounts & state Sec. 1616, 1634 & 209(b) eligibility arrangements

Good sources for state parent & childless, non-disabled adult income levels are “Where Are States..? Medicaid &
State..Elig. . Levels For..Adults” [pub. # 7993, Tables 1-3] and “Medicaid.. [and MSP] .. Elig... [Levels]..for the
Elderly &..Disab[led] ..” [pub. # 8048, Tables 1 & 6] in the Medicaid pages at www.kff.org (updated data is expected
in January, 2011).

At www.kff.org see “Medicaid Expansion Now..[Can].. Save…States Money” ( 4/1/10), saying states can augment
their health budgets by now being able to get regular Medicaid matching rates for previously fully state-funded medi-
cal assistance for childless, non-disabled adults under 133% FPL; and ―Explaining …: Benefits & Cost-Sharing That
States Can Set For [New] Medicaid Beneficiaries” (Doc. #8092 of 8/9/10).

For federal policy on covering the new Mediciad expansion eligibles, see CMS’ State Med Dir Ltr #10-005, “New
Options for Coverage Under Medicaid” (4//10/10) & State Med Dir Ltr #10-013( 7/2/10) on required “Family
Planning & Benchmark [plus mental health & Rx] Coverage” of new eligibles at www.cms.gov.

“Medicaid Coverage & Spending in Health Reform: For Adults ..Below 133%..” at www.kff.org projects the num-
bers of new Medicaid patients & states’ very, very small added share of costs starting in 2014 (only 0% to10%).




                     The Ryan White CARE Act, Title II, Community AIDS National Network, Inc.                            13
“Net Effects of the Affordable Care Act on State Budgets”at www.firstfocus.net
calculates state savings of $40.6 to $131.7 billion from health reform yearly in
2014-2019. Also, The Act & other measures give states a 90% match to improve
Medicaid & insurance exchange eligibility & enrollment sytems & 75% for their
continuing operation
www.kff.org/medicaidbenefits/ lists state chiropractor, podiatry, eyeglasses, optometry, hearing aid, hospice, psycholog-
ist, prosthetics, home health, medical equip, dental, Rx’s, OTC items & phys, occup & speech therapy coverage, 2003-8

GAO Report 11-96 at www.GAO.gov , “Efforts Underway To Improve Children’s Dental Services…” reports that
only 37% of Medicaid children got dental care in 2009 (and the rate was probably much lower where child dentistry is
included in (rarely fully-reported data on) services covered by the many state Medicaid managed care contract plans

See “The GOP’s Health Care Plan for Poor People…” (12/17/10) among the “Citizen Cohn” articles at www.tnr.com.
and also see “The President’s Message: A Full Plate for Medicaid in 2011” at www.hschange.org

PA says CMS found its payment & eligibility error rates to be ½ the US average (call Michael Race at 717-783-1116)

See various guides on how to block bad state plan amendments at www.healthlaw.org. and http://www.nachc.com .

The “National ADAP Monitoring Report, 2009” at www.kff.org , lists state income & asset levels in Table XIX and
their policies to coordinate with Part D in Table XXVI. The Report also covers state cost sharing rules and medical
criteria and/or prior authorization for special or costly drugs. State formularies are listed in a 2nd adjacent document.
See “ADAP Watch” at www.NASTAD.org for news of state waiting lists, cost containment measures & state websites.
Check www.ADAPAdvocacyAssociation.org for more ADAP news/ data and for issues of the “ADAP Pill Box”.

See “Pharm. Benefits [in] State [Medicaid]” at www.npcnow.org on formularies, fees, prior auth, prescribing/dispen-
sing limits & co-pays. JCoburn@hdadvocates.org has a chart on how Rx maker PAPs mesh with Pt D. States can cover
Pt-D-excluded Rx’s with their own funds: see which do so at www.medicareadvocacy.org (12/1/05 rpt. at “News” icon)

See “Indiv…Models of LTC’ at www.statehealthfacts.org for state coverage of HCB waivers, home health, personal
aides, etc. & “Money Follows the Person 101” at www.nsclc.org. See www.healthlaw.org for amounts of 2009 state
Personal Needs Allowances (PNAs) for SNF & ICF patients & residents of SSP-funded, licensed board & care homes.

See www.naschip.org on the pre-health reform state risk pools & order “Comp. Health Ins. for High Risk Indivs: ..
State-by-State…”on funding, eligibility, benefits, Medicare supplements, premiums & low income premium discounts.
www.pcip.gov shows if new US health reform-funded risk pools are state- or federally-run & their premium amounts.
Also see “Pre-existing Condition Insurance Plan” (8/10/10) & its excellent bibliography at www.HealthAffairs.org .

See the “Directory of..[the 27]..State Kidney Programs”with contact, eligibility & benefit data under “publications”
at http://som.missouri.edu/MOKP/ . FL, MI, NJ & TX health depts. also have epilepsy and/or hemophilia aid programs

See ”From CANN ” in “Other Organizations’ Materials” under ”Medicaid”, below “Issues”
at www.healthlaw.org for “ Painless Ways To Deal With State Medicaid Budget Shortfalls”
to avoid eligibility & benefits cuts; ; a health policy & Medicaid “Glossary”; and “2010-11
VA Health..Benefits”



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