Program administrator Helen Sablan and the governor’s special adviser on Medicaid, Esther Muña, disclosed that the CNMI Medicaid Office has already received initial approval from the Medicare and Medicaid Office in Region 9 to eliminate optional services being provided to program beneficiaries.
Both said the proposed benefit cuts were submitted in April and the Medicaid Office has 120 days or until this month to approve the plan.
Mandatory services that would be left covered under the new state plan are in-patient services, out-patient services, other laboratory and X-ray services, nursing facility services, physician’s services, early and periodic screening, diagnostic and treatment for children under 18, home health care, family planning, and rural health clinic when referred to off-island.
The optional services that will be cut are clinic services, optometry services, other practitioner services, dental, physical therapy, occupational therapy; speech, hearing, and language disorders; prescribed drugs, dentures, prosthetic devices, eyeglasses, wheelchair, medical supplies, rehabilitative services, and transportation to off-island facility.
Medicaid is a health program for people and families with low incomes and resources. At present, the federal government shoulders 55 percent of the cost, while the local government puts up a matching share of 45 percent.
According to Muña, once they receive the formal approval from Medicare, the state plan will be sent to medical providers.
Once implemented, Medicaid expects a savings of over $1 million.
Medicare was informed
Sablan told Saipan Tribune that, as a courtesy, her office has been keeping the Region 9 Medicare Office abreast on what’s been happening with the program lately, particularly the suspension of services by many private medical providers who have not been reimbursed since fiscal year 2011.
As of this week, three providers have suspended services to Medicaid patients: PHI Pharmacy, Marianas Medical Center, and Saipan Health Clinic. They said Medicaid patients will have to pay out of pocket if they still want to avail of these providers’ services.
The three companies have yet to state when they will resume services to Medicaid patients, saying it will all depend on how much they could collect from the Finance Department.
Sablan and Muña blame the non-payment of reimbursements on the matching requirement for the program, which they believe is unfair to the CNMI. The program’s current 45-55 matching ratio will go back to 50-50 in 2014. Other states in America, they said, enjoy 100 percent coverage while others have 75-25 matching requirements.
Due to the difficulty in finding local money to match the federal share, arrears to vendors continue to balloon. For off-island and on-island private providers, the unpaid obligation now amounts to over $15 million.