Medicaid budget request brings debate and frustration

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MONTGOMERY, Ala. (AP) — Alabama's Medicaid commissioner told lawmakers Wednesday that the agency will need an additional $156 million to maintain services next year, a funding request that caused lawmakers to criticize the expense of the health care program and its recipients.

Medicaid Commissioner Stephanie Azar said the program faces increased costs from inflation and owes money to the federal government because of overpayment.

"I don't envy the legislature in trying to determine that revenue, but it's not going to be a good set of circumstances. If we were to be level-funded like we were last year, we would have to cut every optional service that we have, such as hospice, outpatient dialysis and other optional programs," Azar said.

Azar said the agency will need at least close to that amount to continue the implementation to managed care through Regional Care Organizations, something the state hopes will help contain cost in the future.

One million Alabamians receive Medicaid. A little more than half of those recipients are children under the age of 18. Azar said there are very few abled-bodied adults who receive Medicaid in Alabama.

Lawmakers expressed frustration about the cost of the health care program for the poor and disabled and some criticized recipients.

"Unless we can get control of Medicaid, it could be the downfall of everything," Rep. Lynn Greer, R-Rogersville.

Sen. Larry Stutts, an obstetrician, said he has seen Medicaid patients call ambulances when they are in labor, while his private-insurance patients never arrive at the hospital that way.

"When we look at what we're asking taxpayers to subsidize, it's absurd how much waste there is," said Stutts, R-Muscle Shoals. Other members criticized emergency room usage by Medicaid recipients.

Democrats on the committee said most people on Medicaid in Alabama are children of the working poor or are disabled adults, and might have difficulty getting to doctor's appointments because of transportation issues.

"They're really poor people, correct," said Rep. John Knight, D-Montgomery.

Azar said there is little the state can do to restrict programs since the federal government provides 70 percent of the money and sets the Medicaid rules.

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