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April 25, 2004Medicaid trims cutting deep
Record-Eagle/John L. Russell Sheri Gallo, 38, is beginning to get around with her new artificial leg, and uses a cane and walker while wearing her prosthetic. She also has serious dental problems. Medicaid has approved the removal of 18 of her teeth but not for the necessary anesthesia and hospitalization. Some without basic health careEditor's note: As the state strains to find ways to balance its budget, there's a human toll. In this article and an accompanying story in Northern Living, the Record-Eagle explores the status, significance and impact of cuts to government-sponsored Medicaid health insurance on low-income individuals and families.By Record-Eagle staff writer TRAVERSE CITY - Richard Porter couldn't obtain Medicaid to get his teeth fixed - until the ibuprofen he took for pain ate a hole in an artery and he ended up in the hospital. "If I could have got those teeth taken care of before, I probably wouldn't have been in the hospital," he said. Porter, 30, of Mancelona, is one of nearly 52,000 Medicaid enrollees in a 13-county region of northwest Lower Michigan affected by recent state cuts to Medicaid services. On Oct. 1, the government-sponsored health insurance for low-income people stopped funding routine dental care, hearing aids and batteries, podiatry and chiropractic services for adults. A Senate subcommittee has voted to restore the benefits, but the plan depends in part on funding shifts and revenue from Gov. Jennifer Granholm's proposed 75-cent increase in the cigarette tax. As Congress prepares to take up the bill, advocates for maintaining Medicaid funding are doing a slow burn about the cuts' impact on clients. "There are so many elderly who use Medicaid for their services, either in nursing care facilities or adult foster care," said Deanna Kelly, personal health administrator with the Grand Traverse County Health Department. Also hard hit are people with disabilities and pregnant women. Since the cuts, many have gone without crucial services like tooth fillings to prevent advanced decay and infections, Kelly said. Medicaid continues to fund extreme emergency dental services for adults, but the focus now is on pulling teeth instead of saving them. "Or (people) find themselves in urgent care or the emergency room, which is so much more expensive," Kelly said. Porter, who enrolled in Medicaid for the first time in January after being laid off from his job for the winter, wound up in the intensive care unit at Munson Medical Center with complications from two untreated teeth. "They were toothaches, but they were giant holes in my teeth, cavities," he said. "I knew that they were bad for several months. I also knew that unless you had an emergency, Medicaid wasn't going to pay for anything." To relieve the pain, Porter began taking ibuprofen three or four times a day at twice the recommended dosage. On Feb. 1 he awoke from a nap vomiting blood. He said doctors told him the medication had eaten a hole in an artery near his esophagus. "I could have prevented it. It's all my fault," said Porter, who now has a full-time job with dental benefits. "But sometimes you just don't have the means of going to the dentist and that's what Medicaid is for." Dental health isn't the only area to suffer from the Medicaid cuts. The elimination of podiatry services is a particular concern among people with diabetes, a complex metabolic disease that slows healing. What starts as a foot blister could develop into an infection that, left untreated, could lead to amputation. "Foot care is critical, especially for seniors and those with circulatory problems, like diabetics," said Georgia Durga, director of the Grand Traverse County Commission on Aging. "Lots of diabetics lose limbs, legs." While the Commission on Aging offers its own nurse-run foot-care program, only seniors 60 and older are eligible. They must pay for the services - $18 at clinic sites and $36 if provided in the home. To help make up for the Medicaid cuts, many area social services programs are trying to step up their own efforts. Now that Medicaid no longer pays for hearing aids, which start at about $2,000 a pair, the Traverse City Lion's Club is fielding many more applications, said Paul Hanrahan, an audiologist at Munson Medical Center. Hearing is so often taken for granted that people with normal abilities don't realize the impacts of hearing loss - social isolation, career choices, job training and promotions, Hanrahan said. The state made the Medicaid cuts in an effort to save $12 million in the 2004 budget. There's been a backlash by advocates since then, said T.J. Bucholz, spokesman for the Michigan Department of Community Health. "But I think people also have a keen understanding that difficult decisions have to be made when the state is faced with a budget deficit of the enormity Michigan has," Bucholz said. Even as Michigan's tax revenues have fallen, demand for Medicaid services and the costs of providing them have shot up, said Fred Keeslar, health officer with the Grand Traverse County Health Department. The state now spends 25 percent of its general fund on Medicaid coverage. To restore the cut benefits, the state must either increase its revenues through cigarette or other taxes or make cuts in other departments. Even if the so-called "sin tax" passes, it's an unreliable source of income for Medicaid because the very nature of the tax is to discourage smoking by making cigarettes less affordable. "The more effective it is, the less revenue it produces," Keeslar said. "So it's not a good revenue stream for us."
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