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In June of 1988, with the Legislature just behind us, it seems a little crazy to be thinking about the state's budget - and potential cuts - for 1990. But program planners around the state are doing just that.

Actually, it's not that unreasonable. The next legislative session will set that budget, and it will go into effect next July.Gearing up for that, low-income advocates were recently given a preview of some of the options for containing Medicaid costs for '90.

According to the Division of Health Care Financing, which administers Medicaid, if it is forced to operate on 1989 budget levels in 1990, the program will be short $22 million dollars ($5.7 million of that state funding).

That shortfall might be manageable, but it comes on the tail of several years of cuts. Beginning this July, the program will operate with a $13 million cut together and the program is severely handicapped.

Rod Betit, director of Health Care Financing, said that Medicaid, starting next month under the '89 cuts, will be basically a "status quo" program.

But even "status quo" is no help to 7,000 adults with no access to dental care, 130 nursing home residents who will lose part of their coverage, and as many as 200 families and Aid to Families with Dependent Children (welfare) that will lose Medicaid eligibility because the Department of Social Service has lowered the Standard Needs Budget on which eligibility is based.

While the low-income advocates are reeling from those cuts, they have been given a whole new set of worries to consider. Nothing has been decided yet, but the following are changes being considered in Medicaid programs for 1990, should more cuts be necessary (The way the Legislature has funded the program recently, "hacks" might be a better word for the reduction.):

-Categories may be cut from the "Medically Needy" program, For example, adults might be eliminated. The program is not federally mandated and reduction could provide a solution to part of the money problem.

-Some money might be saved through the use of copayments - for example, a $1 copayment on prescription drugs.

-Because emergency room use is expensive and over-used, according to officials, restrictions might be used to ease the burden. In cases of questionable urgency, patients might be told to return during day clinic hours.

-The division is considering promoting the use of Health Maintenance Organization (HMOs) and may decide to restrict when a patient can change doctors.

-Medicaid "overusers" may be targeted for mandatory conferences with Health Program representatives.

-Medicaid might contract with specific providers for all Medicaid business.

-The goal of keeping elderly recipients in the community and out of nursing homes might be realized by creating a special "social HMO".

Two other acres that might be worked on are focusing more aggressively on third-party payments, and increasing client education on appropriate Medicaid use.

The advocates were blunt in rejecting all of the proposals, saying they unnecessarily injured the people who are least able to defend themselves from such cuts.

But despite the protestations, the bottom line remains the same: Cuts have to come somewhere unless the Legislature can be convinced that Medicaid is important and must be adequately funded.

Several advocates suggested that the surplus be used to boost Medicaid programs. But Dr. Suzanne Dandoy, director of the Department of Health, said using one-time surplus monies is dangerous because there's no guarantee the money will ever be available again, which might mean more drastic cuts later.

The answer probably lies in prying more money out of the lawmakers, if it's possible. But that will have to be accomplished by the advocates and clients. The department are accountable to the Legislature and the governor, so their hands are tied.

Which is why it's time, in June of 1988, to start thinking about the 1990 budget. Because, if cuts are going to be avoided, a game plan has to be made soon, If no one offers legitimate suggestion befor the decisions are set in concrete, there shouldn't be complaints - or debates - about it afterwards.