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The county budget and Medicaid

By Howard B. Owens

The future of Genesee Justice wasn't the only matter discussed at the county budget hearing a week ago. County Manager Jay Gsell made a presentation about the county's entire budget picture.

Among the most interesting slides were those dealing with Medicaid. As the pie chart above shows, Medicaid accounts for 41 percent of the county's property tax levy, even though only 10 percent of the county's residents are eligible for benefits.

Federally mandated medicaid services:

  • Inpatient Hospital Services
  • Outpatient Hospital Services
  • Physician Services
  • Medical and Surgical Dental Services
  • Nursing facility services for individuals aged 21 or older
  • Home Health Care (Nursing, Home Health Aide, Medical Supplies and Equipment)
  • Family Planning Services and Supplies
  • Rural Health Clinic Services
  • Laboratory and X-Ray Services
  • Nurse Practitioner Services
  • Federally Qualified Health Center Services
  • Midwife Services
  • Early and Periodic Screening, Diagnosis and Treatment Services for individuals under 21 (Child/Teen Health Plan in NYS)
  • Medicare Coinsurance and Deductibles for qualified Medicare beneficiaries for Chiropractors, Podiatrists, Portable X-Ray and Clinical Social Work Services

Additional mandated services covered by NYS Medicaid:

  • Free-standing Clinic Services
  • Nursing Facility Services for under age 21
  • Intermediate Care Facility Services for the Developmentally Disabled 
  • Optometrist Services and Eyeglasses
  • Physical, Speech and Occupational Therapy
  • Prosthetic Devices and Orthotic Appliances
  • Dental Services, Audiology and Hearing Aids
  • Clinical Psychologist Services
  • Private Duty Nursing
  • Diagnosis, Screening, Preventive and Rehabilitative Services
  • Personal Care Services
  • Transportation to Covered Services
  • Hospice
  • Case Management
  • Inpatient Psychiatric Facility Services for Individuals under age 21 and over 65
Bob Harker

I assume that prescription coverage is under another heading. This includes a 50 cent - $2.00 copay that recipients are NOT required to pay - and routinely don't. The filling pharmacy eats that.

Another unique thing about medicaid in NY: Unless changed VERY recently, NY is one of a small handful of states in which fertility drugs are 100% covered for recipients. Recipients cannot support themselves and any existing children, yet taxpayers foot the bill to increase their chances of having more!

Call me what you will - I find that ridiculous, a fast track to deeper debt, and a result of ever increasing political correctness.

Nov 26, 2010, 5:43pm Permalink
C. M. Barons

From Daily News Central (.com)

29 May, 2005 20:10 GMT

Nearly 800 convicted sex offenders in 14 states got Medicaid-funded prescriptions for Viagra and other impotence drugs, according to a survey by The Associated Press. The majority of the cases were in New York, Florida and Texas.
Medicaid, the health insurance program for the poor, is administered differently in every state. Thus, while some states allowed Medicaid payments for prescriptions for the drugs Viagra, Cialis and Levitra, other states did not.
New York, acting on a tip, was the first to uncover that Medicaid had paid for Viagra prescriptions for sex offenders. Its report prompted the federal government, which provides states with funds for Medicaid, to order states to take steps to stop the coverage for these felons.
The states that provided registered sex offenders with subsidized impotence drugs are Florida, 218 cases; New York, 198; Texas, 191; New Jersey, 55; Virginia, 52; Missouri, 26; Kansas, 14; Ohio, 13; Michigan, seven; Maine, five; Georgia, three; Montana, three; Alabama, two; and North Dakota, one. That comes to 788 cases.

Nov 27, 2010, 3:17pm Permalink
Bob Harker

These are not fertility drugs, CM. They address male ED.

I was referring to fertility drugs, which ARE still covered by medicaid. They effect and enhance a female's ability to conceive.

Nov 27, 2010, 5:44pm Permalink
Timothy Hens

Medicaid is the 800 lb Gorilla in the room that no one wants to acknowledge, let alone address. This one program is solely responsible for the poor fiscal condition of the state and is also the program bankrupting most county budgets. Until this program is curtailed and brought down to federal minimums, it will continue to bankrupt New York.

Nov 27, 2010, 10:44pm Permalink
C. M. Barons

Bob- I know the difference between fertility and ED drugs. (Although poverty isn't a crime) your assertion that families too poor to support themselves shouldn't avail Medicaid-funded fertility drugs shares similar degree of irony with sex offenders eligible for Medicaid-funded ED treatment.

The feds dropped the ball on healthcare reform. The partisan divide turned a critical issue into a debate over private or public payer. The whole process was decided through the lens of the healthcare lobby and the public was ignored.

If the private insurers want to own healthcare management, let them- but not unregulated and not by dropping people who get sick. Risk pools should be set up that- like bank funds -are guaranteed by the fed. The pools should be funded by a portion of subscriber premiums, insurance company profits and tax dollars. Insurers wouldn't have to dump subscribers with high healthcare costs or those unable to afford premiums.

Nov 28, 2010, 1:43am Permalink
John Roach

Risk management pools, similar to auto risk pools, were suggested. But as you mention, never considered.

Your idea is good, but leaves out two things I think should be done. One, government could not mandate coverage for things like ED and fertility drugs. Two, we must be allowed real competition. Allowing us to buy health insurance from whatever company, anyplace in the country, like auto insurance.

Nov 28, 2010, 7:47am Permalink

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