ANNAPOLIS -- A House budget subcommittee spent four hours yesterday trying to rein in the cost of Medicaid but found it hard to do without throwing the frail out of nursing homes, or leaving the sick without medicine, or denying treatment that could keep poor people alive.
Even so, the Appropriations subcommittee chaired by Del. Howard P. Rawlings, D-Baltimore, managed to put a small dent in the $1.9 billion program, finding ways to trim or change medical care programs for the poor that could save as much as $31.7 million.
But given the size of the overall program and its rapid growth -- one Marylander in every 10 is on Medicaid -- Mr. Rawlings conceded that the effort was "feeble" at best.
Among the subcommittee's more controversial recommendations:
* To levy a $750 per year "provider tax" on every nursing home bed in the state, a move designed to attract matching federal Medicaid funds to Maryland that would make an additional $9 million available to cover the cost of other Medicaid programs.
* To push for legislation that would require families of Medicaid recipients who are in nursing homes to shoulder some of the cost. Families with incomes above 200 percent of the poverty level but below $50,000 a year would have to pay $100 a month for such care, and those with incomes over $50,000 would have to pay $200 a month. The estimated savings were $2 million.
* To refuse to cover the cost of non-emergency care for Medicaid recipients who go for treatment to hospital emergency rooms. Savings for that costly care were estimated at $4.5 million, although the Maryland Hospital Association complained that hospitals will once again simply get stuck with the tab. Ultimately, all hospital patients help pay the cost of uncompensated care through higher hospital rates.
But the subcommittee found it had little stomach to act on some of the more drastic ideas before them, including proposals to eliminate a variety of expensive but technically "optional" state Medicaid services, such as one program that provides life-saving kidney dialysis medication for some 2,880 recipients.
The panel also rejected elimination of another big-ticket "option," the $46.4 million program that provides medical care for poor people who do not qualify for the federal Medicaid program.
Even some relatively small savings suggestions were voted down because subcommittee members said they feared the effects on recipients. A $1.9 million proposal to limit the number of reimbursable visits Medicaid recipients with psychiatric problems can make to community mental health centers, for example, was killed.
Mr. Rawlings said he had hoped to trim at least $37 million from the program, a target set by a legislative budget work group, and possibly as much as $67 million by including a variety of recommendations pushed by House Speaker R. Clayton Mitchell Jr., D-Kent, a gubernatorial commission on economy and efficiency in government, and others.
"But it is difficult to achieve that level of savings without extreme damage to people," Mr. Rawlings said after the voting session.
Several proposals would have raised -- retroactively -- eligibility criteria for nursing home care, changes that ran the risk of putting longtime nursing home residents out on the street. Those ideas were quickly rejected.
Among the recommendations adopted were measures designed to reduce the cost of providing prescription drugs, both by increasing the "co-pay" amount for Medicaid recipients and by limiting the types of drugs dispensed to those made by pharmaceutical companies that agree to provide price rebates to the state for its bulk purchases.
Today in Annapolis
10 a.m.: Senate convenes, State House.
11 a.m.: House convenes, State House.
1 p.m.: Senate Economic and Environmental Affairs Committee considers bill to abolish delegate and senatorial scholarship program, Room 200, Senate Office Building.
2:30 p.m.: Gov. William Donald Schaefer holds news conference regarding bone marrow donors, State House.
There are 25 days remaining in the 1992 General Assembly session.