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Some states cutting costs by limiting Medicaid coverage of hospital visits

State Rep. Matt Hudson, R-Naples (Pic by Mark Foley, via myfloridahouse.gov) Kaiser Health News and USA Today report that Florida is among a slew of states that have been cutting costs by limiting hospital coverage in their Medicaid plans

Thomas Dixon
Last updated: Jul 31, 2020 | Oct 24, 2011

Kaiser Health News and USA Today report that Florida is among a slew of states that have been cutting costs by limiting hospital coverage in their Medicaid plans. Last week, an official for Florida’s Agency for Health Care Administration suggested that the state further cut coverage to a maximum of 12 emergency room visits a year for each Medicaid beneficiary. Arizona and Hawaii are currently waiting for federal approval of their plans to cut hospital coverage in their plans, much like Florida already has.

“Advocates for the poor and hospital executives say the moves will restrict patients’ access to care, force hospitals to absorb more costs and lead to higher charges for privately insured patients,” Kaiser/USA Today reports. “States defend the actions as a way to balance budgets hammered by the economic downturn and the end of billions of dollars in federal stimulus funding this summer – funds that had helped prop up Medicaid, the state-federal health insurance program for the poor.”

Florida is already among the list of states that have limited hospital coverage for Medicaid recipients in an effort to cut costs. The state’s Mediciad program currently only covers 45 days in a hospital for its beneficiaries.

Last week, acting Medicaid director Justin Senior told a Florida House health care committee that the state “could reduce home health visits for Medicaid beneficiaries and slash the amount of inpatient hospital care the program covers,” The News Service of Florida reported.

Senior said the state could limit emergency room visits to a maximum of 12 a year for each Medicaid recipient, which he said could save the state $12.2 million.

State Rep. Janet Cruz, D-Tampa, raised concerns for terminally ill patients who typically need more hospital visits. However, other members of the panel were “receptive” to the idea, the News Service reported:

Chairman Matt Hudson, R-Naples, said such a move could drive people to get treatment from primary-care doctors instead of emergency rooms, which could improve their health care.

Rep. John Wood, R-Winter Haven, appeared miffed that some Medicaid beneficiaries might go to the emergency room more than once a month, calling it “unacceptable.”

“If we’re allowing that type of behavior, shame on us,” Wood said.

Health advocates for low-income people are among those opposed to plans by states to limit hospital coverage for Medicaid patients.

Kaiser and USA Today report:

In Alabama, which has had a 16-day limit for more than decade, hospitals have billed patients for days not covered by Medicaid, said Larry Gardella, director of advocacy at Legal Services Alabama. Because poor patients often are unable to pay, the hospitals typically must pick up the cost, he said.

Another problem: Patients may also delay seeking elective services if they’ve already reached the coverage limit, Gardella said.

The state Legislature made significant cuts to the Florida program in the past year. Hospital coverage has been just one of the services that has been limited for Medicaid beneficiaries as the state aims to cut costs.

Thomas Dixon | He creates the ideal marketing experience by connecting online brands with their target audiences. He recently completed a research paper on consumer conversion and took part in a community project on SEO optimization. Thomas is working on his Bachelor of Arts in Communications and plans to intern in an online marketing department soon.


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