Kaiser Daily Health Policy Report Round Up Recent Action in States’ Medicaid Programs

The following examines recent developments regarding states' Medicaid programs.

• Mississippi: State Medicaid officials are considering implementing a tiered copayment structure for prescription drugs, the AP/Memphis Commercial Appeal reports. Medicaid beneficiaries currently pay $3 per prescription, but in an effort to encourage them to select generic over brand-name medications, the program may begin to charge $1 for each generic drug, $2 per name-brand drug that is included in the state's formulary -- set to begin July 1 -- and $3 per name-brand drugs not on the formulary. Medicaid officials also are holding a series of meetings with lawmakers to address the program's anticipated $120 million budget shortfall (Wagster, AP/Memphis Commercial Appeal, 6/12).
• Oklahoma: Because of the state's "tight budget," state officials have delayed implementation of a program that will provide Medicaid benefits to uninsured women diagnosed with breast or cervical cancer through a CDC screening program (Hinton, Daily Oklahoman, 6/11). Under the Breast and Cervical Cancer Prevention and Treatment Act, signed into law in October 2000, states can expand their Medicaid programs to include uninsured women under age 65 who have breast or cervical cancer (Kaiser Daily Health Policy Report, 12/7/01). Oklahoma officials estimate the state's cost for the program will be $1.1 million annually. Unless funding becomes available, the state will not be able to implement the program on its scheduled Jan. 1, 2003, start date, the Daily Oklahoman reports. In other Medicaid news, the Health Care Authority, which manages Oklahoma's program and is scheduled to meet on June 13, is expected to "permanently reduce" coinsurance and deductible payments by 15% for individuals dually eligible for Medicaid and Medicare (Daily Oklahoman, 6/11).
• Texas: State Health and Human Services Commissioner Don Gilbert is seeking permission from the federal government to begin charging Medicaid beneficiaries copayments of up to $3 for prescription drugs and emergency room care. If approved, the plan would be implemented after Sept. 1. The state Legislature last year authorized the copayments, which are expected to save the state $3 million annually. Gilbert rejected a different plan floated by health advocates that would have implemented a voluntary $10 annual enrollment fee for beneficiaries (Selby, San Antonio Express-News, 6/11).
• Utah: Medicaid beneficiaries who were able to recover settlements from insurance companies because of an injury have filed a class-action suit against the state Department of Health with the state Supreme Court. The suit is an attempt to "strike down" the state's policy of using patients' settlement money to cover their Medicaid bills. Under the policy, the state uses patient settlement winnings to reimburse itself for health services provided to injured beneficiaries and gives any leftover funds to the beneficiary. Attorney Robert Sykes, who is representing the Medicaid beneficiaries, alleges that the policy violates federal law by placing liens on property to cover medical expenses. Sykes said, "The state may recover in full ... under some circumstances. But what it shouldn't do is impoverish people that the Medicaid program is designed to protect." However, the state says -- and the state Supreme Court previously has ruled -- that because the lien is actually placed on funds held by the insurer, it is not violating federal law. The suit seeks to create a new payment system and to reimburse beneficiaries retroactively for funds "lost out over the past seven years" (Neff, Salt Lake Tribune, 6/9).