Medicaid for State’s Poorest Costs More

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The 2010 federal health care law that the Supreme Court is currently considering includes a big expansion of Medicaid, the publicly funded health program for the poor.

If the court upholds the law, Colorado offers a glimpse of the future. The state is launching its own Medicaid expansion now, albeit on a much smaller scale.

CPR Health Reporter Eric Whitney says, the state is focusing its efforts on the poorest of the poor.

Below is a transcript of Eric Whitney’s story.

Reporter: Just because you’re completely broke, destitute, doesn’t mean you can get Medicaid in Colorado. Like most states, it limits the health benefits to kids and pregnant women, and the disabled and some elderly people.

That means poor people commonly put off getting healthcare until they absolutely have to. Dr. Marti Shulte sees the consequences at Stout Street Clinic for the homeless in downtown Denver.

Shulte: Well, we see a lot of patients here who have diabetes, and they’re homeless. So, there are issues about where they store their insulin? if they’re sleeping in their car, or sleeping outside. How they get access to high quality food that’s appropriate for their diabetes care?

Reporter: Dr. Shulte says poverty means, people who could be staying healthy, can’t.

Because they can’t get regular medical care, their conditions often crash, requiring expensive treatments that could have been avoided.

Shulte: So the complications I see in a 45 year old I might not have seen in private practice.

Reporter: Complications like?

Shulte : Like amputations or foot ulcers from diabetes, or renal disease in a diabetic who’s 43 instead of what I might have seen in somebody who’s 60 or 65.

Reporter: If the Supreme Court upholds the 2010 federal health care law that it’s currently considering, people like the ones Dr. Shulte sees will be able to get their health needs covered through Medicaid. It’s supposed to expand big time in 2014. Now, though, Colorado is launching its own Medicaid expansion. It’s a much smaller pilot to help the state ramp up to 2014.

Brennan: We essentially set the threshold at 10,000 individuals.

Reporter: Suzanne Brennan is Colorado’s Medicaid director. She says the original plan was to use $95 million a year in new money to offer Medicaid to everyone at federal poverty level or below in Colorado.

Brennan : It was, originally. We did research around the country to understand this population, and based on what we know are their needs, we reduced the number of people who would be eligible for this program.

Reporter: Brennan reduced the number by a lot. 10,000 people represents just seven percent of everyone in Colorado estimated to be at or below poverty level.

Brennan says the state has to limit new enrollment because research shows poor adults cost a lot more to cover than the average Medicaid member.

Brennan: Our average is about $5,000 per year, per member. So this is almost double that, it’s more than double that.

Reporter: It’s an expensive population, but Colorado found a way to come up with an extra $95 million a year for Medicaid. Elisabeth Arenales at the Colorado Center on Law and Policy explains.

Arenales: The money to fund the program comes from the hospital provider fee, that doesn’t rely on taxpayer dollars.

Reporter: The hospital fee was passed three years ago, with the support of Colorado hospitals. They agreed to pay the new fee in to state Medicaid, because they know the federal government matches state Medicaid dollar for dollar so it would go a lot further. And more people on Medicaid means fewer unpaid hospital bills. Plus, hospitals get higher Medicaid payments to better cover the costs of those they do treat.

Arenales : So not only are we able to expand coverage for low income people that are in need of medical care, but we have also helped the hospitals.

Reporter: That’s some pretty fancy policy work, but a little down in the weeds for 37-year old Laura Deshaw-Montes. She’s trying to get health care at the homeless clinic today, and knows what’s important for her.

Montes: There’s this new program they’re going to be doing, I think, that there’s 10,000 people that they’re going to try to pick to get Medicaid.

Reporter: Do you think that would make your life easier?

Montes : Oh, yes! (laughs) a lot easier.

Reporter : Deshaw-Montes is homeless, and says she has chronic health conditions that make it hard for her to work.

Montes: I only make A.N.D., which is aid to the needy and disabled, and I make $175 a month.

Reporter: For now, she gets charity care at publicly-subsidized clinics when she needs it. Having Medicaid could help Deshaw-Montes and people like her do relatively simple, but critical things. Like be able to pick up prescriptions at the pharmacy closest to where they’re staying, versus long bus rides to the homeless clinic. For many, that can be the difference between staying healthy and being sick.

Deshaw-montes is one of an estimated 50,000 people who are expected to apply for the new Medicaid benefits. The state will pick 10,000 in a random process it doesn’t want to call a lottery. Those who win the benefits should know by the middle of May.

This story was produced in collaboration with NPR and Kaiser Health News. Kaiser Health News is not affiliated with Kaiser Permanente.

[Photo: Stout Street Clinic]