Md. Medicaid cut would be costly, care-givers fear 'The middle class will pay for this'

September 27, 1992|By Laura Lippman | Laura Lippman,Staff Writer

If Gov. William Donald Schaefer follows through on his proposal to cut the state's medical insurance program for indigents, it will mean the end of health insurance for 30,400 people -- most of whom receive benefits because the state says they are temporarily disabled.

Hospitals will have to treat these people when they show up with problems requiring immediate treatment or hospitalization. But the cost will be passed on to workers and businesses, as hospitals raise rates to cover their costs, forcing an increase in insurance rates.

"The costs don't go away; they get shifted," said Jeff Singer of Health Care for the Homeless. "In the middle run, the middle class will pay for this. In the longer run, the quality of all our lives will diminish."

Currently, more than 500,000 Marylanders have no health insurance. Andrew Wigglesworth, vice president of the Maryland Hospital Association, said the state is adding to that population at a time when the national debate centers on trying to reduce the number of uninsured people.

Last year, when the state stopped paying for hospitalization under its Medicaid program, it shifted $148 million in uncovered costs onto hospitals, primarily the ones in poor neighborhoods. This year, the governor's proposed $50.2 million cut to state-only Medicaid will end up costing far more, because people will not receive any preventive care.

As a result, the state will have to drop its requirement that its 24,000 public assistance recipients demonstrate they are getting medical care to qualify for grants and loans. The condition was created this year to help control costs, but it is impossible to enforce if the state no longer provides insurance.

State officials say they must make the cuts.

"You can't do it without creating some pain," said Nelson J. Sabatini, secretary for the Department of Health and Mental Hygiene."

"Obviously, it's not the way any of us would choose to do business if we weren't in dire circumstances," said Timothy W. Griffith, director of the Income Maintenance Administration at the Department of Human Resources.

But the state's General Public Assistance Program and Disability Loan Program, a mix of grants and loans that will replace the grants-only system, has always been vulnerable to cuts because it is not mandated by the federal government.

Some states, primarily Southern ones, provide no aid at all to disabled adults, while others have helped out even the able-bodied. Maryland has taken a middle course, providing some form of relief for disabled adults since the 1940s.

Little community support

But the program has little community support, largely because of a public perception that its clients are substance abusers responsible for their own health problems.

"A lot of them are drug abusers and alcoholics," said J. Peter Sabonis, an attorney with the Homeless Persons Representation Project. "But they're not just drug abusers and alcoholics; they have other medical problems, too."

Currently, state Medicaid recipients can check into a hospital detoxification system for three days, if the hospital has slots, said Mr. Singer of Health Care for the Homeless. Without insurance, they will have no chance for medical treatment.

"There was still a glimmer of hope," Mr. Singer said, adding: "now we don't even have that."

The temporary disability program also is a fail-safe for those waiting for a more lucrative federal program, Social Security Income (SSI), earmarked for the permanently disabled.

An estimated 4,000 people on state assistance fall into that category, said Mr. Griffith of DHR, and the state may be able to move them to federal Medicaid, "but it will be difficult if we're inundated with all these cases Nov. 1."

One of those waiting is Darryl A. Jordan, a 30-year-old electrician's assistant shot five times in an unprovoked attack May 9. He had no insurance, so he applied for state-only medical assistance and a loan.

Therapy insurance cut

Paralyzed on his left side, he has a colostomy bag and a bullet in his neck. Since hospital stays for the state-only program were eliminated during last year's budget cuts, Mr. Jordan was never covered for the two operations he needs. But, as of Nov. 1, he also will have no insurance for therapy or doctor's visits.

His only hope is that he will qualify for SSI, which would mean a $400-plus monthly stipend and federal Medicaid benefits. But that process takes at least three months, usually much longer, as many applicants have to appeal.

Mr. Jordan is not an isolated case. The Health Education Resource Organization (HERO) has an estimated 900 AIDS clients who rely on the state program to pay their medical care and prescription costs until they are approved for SSI.

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