HHS Waiver Reduces Benefits for Some

Monday, February 11th 2002, 12:00 am
By: News On 6

WASHINGTON (AP) _ About 25,000 uninsured Utah residents will get some health care under a plan approved Saturday by the Bush administration, but it will cost the state's poorest residents some dental, vision and mental health benefits.

It is the first time the U.S. Department of Health and Human Services has approved a state proposal to expand Medicaid coverage that would reduce coverage for those already on the program.

It drew sharp criticism from advocates for the poor, who feared that dozens of states could reduce benefits and pocket the savings to help them through tight economic times.

``This is part of an overall administration effort to welcome wholesale waivers from many states, and those waivers contradict the protections that Congress established,'' said Ron Pollack, executive director of Families USA. ``We think that these cutbacks are unlawful.''

Stephen McDonald, spokesman for the Utah Department of Health, said all of the money saved by reducing benefits will go to expanding the pool of those covered, meaning the state won't save money based on the changes.

President Bush announced last August that his administration would consider allowing reductions in benefits if insurers expanded coverage.

Pollack said the announcement made it clear that states were welcome to cut benefits, as Utah has done. Washington state has applied for a waiver and Michigan has announced it plans to, he said.

Under the Utah program, poor people would be limited in the number of visits they can make to a physical therapist, chiropractor or psychiatrist, said McDonald. They would not get transportation to a doctor unless there is an emergency and there would be some reduction in speech, vision and dental benefits.

The changes would apply to between 17,000 and 20,000 people on the Medicaid rolls, but would not affect benefits for pregnant women or disabled participants.

Another 25,000 people who now have no health care coverage will get a bare-bones package, which will cover doctor visits, dental visits and some transportation, but will not pay for inpatient hospital services.

Those making up to 1 1/2 times the poverty level _ which would equal $12,885 per year, the equivalent of working a full-time job at $6.19 an hour _ will be covered.

``If you get sick you can see your doctor now. You can actually get a checkup now. You can get an X-ray,'' said McDonald. ``These are working individuals who can't afford health insurance. Twenty-five thousand are going to get it.''

They will have to pay $50 annually for the coverage, which Pollack said is a burden on the already-poor.

Health and Human Services Secretary Tommy Thompson and Utah Gov. Mike Leavitt announced the approval of Utah's waiver application at a news conference Saturday afternoon.

The announcement comes the day after the opening of the 2002 Winter Olympics, which are attracting media attention from around the world.

In his Jan. 28 State of the State address, Leavitt called for adding coverage for 25,000 ``with no additional state cost by changing our strategy to provide basic health care to many rather than unlimited care to a few.''

``It is the kind of common sense that will bring health care to tens of thousands of Utahns who need it and currently do not have it,'' he said.

The Utah Legislature has also approved a bill that would allow insurance providers to offer a stripped-down plan to small employers and low-wage earners in an effort to try to cover more uninsured residents.

Leavitt signed the bill into law on Saturday.