By By Anna M. Lee Boone News Service
Since December, Alabama's Medicaid program has been three to four weeks late with payments to Alabama's health care providers for the work they do to care for Medicaid patients.
Like other practices statewide, Brewton pediatrician Marsha Raulerson's office did not receive its February payment until March 11.
"The state has a shortfall this fiscal year of $60 million for Medicaid," Raulerson said. "There is no solution to that that I can see, other than new taxes. There has to be some new taxes earmarked for health care. There's no way that you can make accountability so good that's going to save $60 million."
Medicaid funding is a critical issue to Raulerson and her practice, as 58 percent of her patients are on Medicaid. Statewide, half of all children under the age of six and 47 percent of pregnant women use Medicaid.
As president of the Alabama Chapter of American Academy of Pediatrics, Raulerson has been working to make the needs of Medicaid patients and and the doctors who treat them clear to those who make Medicaid funding decisions.
"We are talking to our legislators about the need for new funding to support children's health care," she said.
A few of the proposed funding solutions suggested by Raulerson include an increased tax on tobacco and a tax on soft drinks, Gatorade and bottled water.
In response to current problems with Medicaid funding, Raulerson and other doctors have had to modify their policies.
"One of the things that we've done here is we're not taking new Medicaid patients. We'll take care of the ones we have, but we're not taking new ones. We can't afford to," Raulerson said. "We had 1,200 Medicaid patients here, and we're trying to cut that down some. Many pediatric practices are closing to new patients or setting a cut-off."
Raulerson has also decided not to see patients who "doctor shop" or go from one doctor to another.
"Our feeling is Medicaid's not paying us and if the patient's not going to respect our office and to do the right thing as far as cost of health care then they can't come here anymore," she said. "We try to teach our patients that this is a medical home, and by medical home, we mean that they come here for their routine care, their preventive care and when they're sick."
Until recently, Medicaid supported the concept of a medical home through its Patient First program, but that program has now been discontinued. By not paying doctors a $3 per member per month fee for participating in the program, Medicaid saved $12 million.
"It was a case of saving money now, but it's going to cost you more later on," Raulerson said. "At least try to preserve the concept of the medical home – it's a better way to care for children."
In another effort to save money, Alabama Medicaid is developing a preferred drug list.
"They had the drug companies bid on how much they would charge Medicaid for the medicines, and they chose the lowest bidder. They didn't choose the best drug." Raulerson said. "In fact, there's not really a best drug. What works for one child is not going to work for another child. We do believe that you should be able to save money on medications, but that shouldn't be the sole reason for why you write a prescription."
Raulerson has been working to make her patients, legislators, and the public aware of the need for Medicaid funding in Alabama.
"Medicaid is a $2 billion business in Alabama. That's more than Mercedes Benz. What does it pay for? It pays for hospitalization, lab work, immunization, outpatient clinics, nursing homes, physical therapy, pharmacies – it's a huge business in Alabama."