Physicians, ambulance companies, dentists and even the Department of Health all want a bigger piece of the Medicaid pie, resulting in a proposed $68.2 million increase in the state's 2001-02 Medicaid Assistance Budget.
Preliminary figures were distributed at a hearing last week where members of the public were invited to discuss medical needs not met through the current programs and specific budgetary requests. The hearing was conducted by the Medical Care Advisory Committee, which advises the Department of Health and Gov. Mike Leavitt about Medicaid funding and program directions.
Kent Roner, the state's Medicaid financial officer, said the $63.4 million requested by the Division of Health Care Financing is simply to keep the current program whole. Without these funds, Roner said, programs will have to be cut or services reduced to meet growing costs.
According to the proposed budget, $37.1 million is needed to keep up with inflationary costs, $17.7 million is required for Medicaid utilization and caseload, $2.5 million is needed to follow a federal mandate making 18 year olds eligible for benefits, $5.7 million will replace one-time funding for ongoing services, and $305,900 is requested for a dental fee increase.
One of the biggest hits in the proposed budget is a $9.5 million loss in federal funds due to changes in the federal match rate. The match rate changes annually based on a state's per-capita income over a three-year period. Roner said the anticipated 1.55 percent decrease indicates Utah's per-capita income went up 5 to 6 percent between 1996 and 1998.
Community requests include $1.9 million for more than 300 working disabled below 250 percent of the poverty level. These funds would allow the state to implement a work incentive program and eliminate a "spend down" requirement for disabled citizens who make more than the federal poverty level. The working disabled would be able to retain their Medicaid benefits while working.
Physicians are asking the state for a 7.5 percent fee increase, which would amount to $4.8 million. Val Bateman, Utah Medical Association deputy executive vice president, came armed with numbers to support his request. The cost-of-living increase between 1988 and 2000 is 39 percent, he said, and the cost of medical services, less prescription costs, has increased 47 percent. Doctors are asking that the fee increase reflect these changes, Bateman said.
"It's getting to the point where there's enough demand that they're going to have to say, 'I've got to see the people who are paying more,' " Bateman said.
Area ambulance companies are requesting similar increases. R. Gene Moffitt, of Gold Cross Ambulance, told committee members that Medicaid reimbursements are declining statewide, leaving the companies to take the hit. In 1999, Gold Cross billed $825,000 in emergency services for Medicaid customers. However, it was only paid $245,000, leaving the company with a 29.78 percent reimbursement rate. Mike Miller of Dixie Ambulance supported Moffitt's numbers and asked the committee to "take seriously pre-hospital care."
At any one time, Roner estimates that close to 130,000 Utahns are on Medicaid monthly, plus 3,000 on the Utah Medical Assistance Program. UMAP is a "safety net" for people who don't qualify for Medicare or Medicaid. During the year, there are roughly 235,000 on Medicaid for more than one day.
The Medical Care Advisory Committee will have one more public hearing before the 2001-02 budget is submitted to the state. That meeting is Aug. 17, at 1:30 p.m. at 288 N. 1460 West, Room 125.