Kansas City, MO – Last year the state cut or reduced coverage for almost 100,000 Missourians from the Medicaid program, leaving many people without dental, eye care, medical equipment or employee disability health coverage. The changes are causing health care providers and patients in Kansas City to find ways to adapt to the changes. Supporters say they've reinstated some of the cuts and that the changes have helped balance the state budget. Now everyone is looking ahead to the future of Medicaid. KCUR's Kelley Weiss reports.
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Mary Carter gets up at 4:30 most mornings to get ready for the day, when she'll be working at one of two part time jobs or taking master's level classes in social work. The 35-year-old from Kansas City is ambitious and driven but she also has Cerebral Palsy. This leaves her bound to a wheelchair that she's dependent on to remain mobile, as well as other equipment she says she can't live without like a lift to help her in and out of bed.
Mary Carter: "I need all of those things to be able to go to school and work and do my internship and pretty much do everything that I do because those things help me to do the everyday things that most everyone else can do on their own."
She still has health insurance but relies on the state to maintain her medical equipment. When the Medicaid cuts passed last year funding was eliminated for breathing aids, prosthetics, hospital beds and wheelchair accessories. Carter says that means if her almost three-thousand dollar motorized wheelchair ever needs repair she'll have no way to cover the repair costs.
Mary Carter: "Even before all the cuts happened and everything, getting anything fixed or anything taken care of was already kind of difficult now it's just all that much more challenging."
Amy Blouin, executive director of the Missouri Budget Project, says thousands of people across the state are struggling to maintain their health care after the changes to Medicaid. She says the cuts don't make economic sense. The state approved a more than $600 million dollar reduction in funding to the program last year which lawmakers estimated would add up to $200 million dollars in state savings. But, Blouin notes that eliminating healthcare coverage for some Missourians costs the state millions in federal funding because Washington matches those funds at more than two to one. And, Blouin says newly uninsured patients then bog down hospitals and indigent care clinics.
Amy Blouin: "We've effectively cut more than 100,000 people in a year from healthcare so they don't stop being sick what happens is they end up going to emergency rooms for their healthcare and it's much more expensive and much more of a threat to the healthcare of our state."
That's the situation Cheri Clark finds herself in. Clark is a 47-year-old full time student. She lost her Medicaid coverage when last year's cuts lowered the income eligibility rate. She says she's healthy or at least for now - she gets seasonal sinus related ear infections and has asthma.
Cheri Clark: "I just pray that I don't get sick. And, when I do get sick I hate to say it that I am going to go to the emergency room if I can't take something over the counter to cure it. It's even getting to the point now where I'm hearing people will call you and ask you if the flu is going around or a virus hey you got any antibiotics' or you have anything for pain because you know I ain't got no Medicaid and I can't go to the doctor' and that's pretty dangerous."
Dr. Peggy Young is the dental director for Swope Health Services. Young says the Medicaid changes eliminated dental coverage for adults.
Peggy Young: "The patient population we're serving has a greater need than the average population and the services have been cut from them that's why we're trying to hang on and provide services for as long as we can to them but like I said it's getting to a point where we really don't have any funding coming it and it makes it difficult to continue services at that level."
Young says Swope will most likely have to scale back its services but she's not sure when that will happen. Swope Health administrators say the clinic took on $1 million more in debt this year to subsidize patients without Medicaid coverage.
But Jessica Robinson, press secretary for Missouri Governor Matt Blunt, says that 900,000 Missourians still have Medicaid coverage. In the 90s, she says, the state greatly expanded Medicaid coverage and that left the state with a huge deficit. She says Governor Blunt found a way to help balance the cost of Medicaid with the changes he approved last year.
Jessica Robinson: "Basically what had been allowed to grow unchecked for almost a decade could be reformed in a way that still provided a safety net for those who needed it most but yet at that same time was something that would not send the state's budget into a disaster area."
Robinson says although the cuts weren't easy they will pay off in the long term by making the program more efficient and limiting the fraud that has plagued the system and caused the state to lose millions of dollars each year. And, she says paring the Medicaid rolls will help keep taxes down.
Jessica Robinson: "These were difficult changes knowing that the changes do and did affect individuals. Time does not change the fact that those were difficult decisions. But the difficult decisions are ensuring that the mistakes of the past are not repeated."
But the way forward is not entirely clear. This year lawmakers and the Governor reversed earlier decisions, rolling back some of the cuts and restoring eligibility to more than 5,000 children's parents. A district court judge may reinstate the cuts that eliminated coverage for medical equipment for low-income Missourians with disabilities. Governor Blunt has repeatedly stated that he plans to end Medicaid in Missouri in 2008 and replace it with a revised program. Critics say completely changing state's complicated Medicaid system it's a long process, and one that would require approval from the federal government. Robinson says the governor isn't ready at this time to release details about the next steps in his proposed overhaul of Missouri's health care safety net.
Funding for health care coverage on KCUR has been provided by the Health Care Foundation of Greater Kansas City.