Virginia health officials, while backing away from the part of a massive Medicaid cutback that would have eliminated aid to 800 nursing home patients, have proposed slashing benefits even more deeply for thousands of other indigent residents.
After unveiling an initial plan to eliminate or drastically reduce benefits to patients, the state is now proposing to direct a second round of cutbacks at medical providers that would sharply curtail Medicaid payments to hospitals and nursing homes. At the same time, however, the state would eliminate health benefits for several new groups of patients -- such as blind and disabled children under 18 -- beyond the 50,000 people they already have targeted for removal from the Medicaid rolls.
The health officials say they offered the latest proposals in response to a storm of criticism from citizens and key state legislators over the initial plan. They argued that poor patients should not bear the full burden of the cutbacks while payments to medical providers remained untouched. But the providers contend that cutting payments to their nursing homes and hospitals inevitably would hurt these same patients in the end.
The two rounds of reductions are designed to close a $50 million gap in Virginia's Medicaid budget next year, less than one-quarter of which has been caused by federal budget cuts. Virginia is one of the first states to use the more flexible rules devised by the Reagan administration to try to slow the soaring cost of the federal health care program for the poor.
Robert Treibly, acting director of Virginia's Medicaid program, said the state had received hundreds of letters of complaint from friends and relatives of bedridden patients after they learned that 800 nursing home patients with income just over $500 a month were slated to lose their Medicaid benefits. That proposal would have saved the state $8 million.
By last week, Treibly said, key state legislators on the appropriations committees were telling him there is no way they would agree to that provision or some of the other items among the $42 million in reductions proposed last month.
"We didn't think people would like it," Treibly said of the original nursing home proposal. "But there's been so much opposition, with letters coming in from all over the state, that the political people are telling us there's got to be a better way of doing this."
The Washington Post reported last month that state health officials have proposed to cut off Medicaid benefits to 35,000 aged, blind and disabled adults, who are just over the poverty line in a category called "medically needy." The officials also proposed an end to free hospital care, eyeglasses and other key medical services for 12,000 children from welfare families.
Now Treibly says he has "offered up a shopping list" of further cutbacks that would save an additional $55 million. But he said the state Board of Health could pick and choose among these proposals and still balance the Medicaid budget once the cutbacks take effect April 1.
Under the options offered under the new proposal, the state could:
* Eliminate coverage of pharmacy, optical and podiatry services for some or all of the state's 286,000 Medicaid patients, along with payments for medical equipment such as wheelchairs. Maximum savings would be $30 million.
* Decline to pay for Medicaid patients who stay in the hospital more than 10 or 12 days at a time, compared to the current limit of 21 days, for a savings of $13.8 million. The state also could choose not to pay for patients to be hospitalized more than 21 days a year or for weekend admissions in non-emergency cases.
Eliminate benefits to thousands of disabled patients under 18, some in state mental hospitals, for a savings of $10 million. These patients fall in the "medically needy" category and can be excluded under the new federal rules.
* Set the income limit for eligible nursing home patients at $875 a month, instead of the originally proposed $500, which would exclude just 40 patients and save $400,000.
* Limit Medicaid payments to nursing homes to 60 percent of the average statewide cost for long-term care, which would save $12 million.
Harley Tabak, who runs Annaburg Manor in Manassas, said this plan would cut his payment for each patient from $48 to $42 a day. "My nursing home alone would lose hundreds of thousands of dollars," he said. "I don't know how we would function, except into bankruptcy.
"We have to make public officials understand that you're still hurting the patient. There's no way we could give the same level of care with less money."
Limit hospital increases for Medicaid patients to 9 percent a year, which together with other technical reductions would save $12 million.
Lawrence Sartoris of the Virginia Hospital Association said this would force hospitals to raise their rates for more affluent private patients.
"The government continues to stimulate demand for these services, to have the illusion of a program, but then refuses to pay the cost," he said. "The inner-city and rural hospitals that treat the most Medicaid patients will be the ones hardest hit."
"I'm a fairly conservative individual, but this is going to put an unacceptable burden on an awful lot of people who in my judgment still need help," said Dr. Leonard Weyl of Arlington, vice chairman of the Board of Health.