Is Your State Eliminating Medicaid Coverage for O&P?
As states look for ways to trim their budget deficits, some state policymakers may be planning to eliminate Medicaid coverage for orthotic and prosthetic services. AOPA firmly opposes these efforts and believes that states should not balance their budgets on the backs of physically challenged individuals who require these valuable services.
Massachusetts, for instance, is planning to abolish O&P coverage for its state-based Medicaid program, called MassHealth, to help alleviate an expected budget shortfall of more than $1 billion in 2003. This cut will go into effect on Jan. 1, 2003. MassHealth pays for health care for certain low and medium-income people living in Massachusetts who are under age 65 and who are not living in nursing homes or other long-term-care facilities.
AOPA views these proposed reductions as shortsighted and exceptionally harmful to those patients eligible for Medicaid and in need of O&P services. State policymakers should not be “cherry picking” the medical conditions that will receive appropriate coverage. And while the goal of eliminating Medicaid coverage is to save state money, it may have the opposite effect. Such a strategy could, in fact, increase state costs through lower tax revenues, since eligible patients who do not receive appropriate O&P services may not be able to return to work. Further, those patients who can no longer work may be forced to use other public assistance programs or rely on other state-covered health care benefits, thereby increasing state spending.
The effects of any reductions or elimination of O&P benefits under Medicaid can have other serious implications. First, it leaves open the possibility that private health insurance will follow suit and cut coverage for O&P services as a cost savings measure. Additionally, once such a policy option is put out for public consideration, it can have the effect of derailing more proactive legislative efforts such as licensure or parity legislation by forcing state associations to focus their limited resources on maintaining the status quo.
AOPA suggests that all state O&P associations explore whether their states are considering the elimination of Medicaid coverage for O&P services.
If you would like assistance contacting your state Medicaid office, please call AOPA’s director of legislative affairs Walt Gorski at (571) 431-0809.
