Every day for nearly 18 years, Alessandra Fabrello has been a medical caregiver for her son, on top of being his mom.<\/p>\n
\u201cIt is almost impossible to explain what it takes to keep a child alive who should be dead,\u201d said Fabrello, whose son, Ysadore Maklakoff, experienced a rare brain condition called acute necrotizing encephalopathy at 9 months old.<\/p>\n
Through North Carolina\u2019s Medicaid program, Maklakoff qualifies for a large slate of medical care in the family\u2019s home in Chapel Hill. Fabrello said she works with staffing agencies to arrange services. She also learned to give the care ordinarily performed by a doctor, skilled nurse, or highly trained therapist because she often can\u2019t get help.<\/p>\n
Now, broad cuts to North Carolina Medicaid will make finding and paying for care even more difficult.<\/p>\n
Nationwide, states are scrambling to close budget shortfalls and are eyeing Medicaid, generally one of a state\u2019s biggest costs \u2014 even before President Donald Trump\u2019s hulking tax-and-spending law decreases federal spending on Medicaid by about $1 trillion<\/a> over the next decade.<\/p>\n North Carolina and Idaho have already announced plans to cut Medicaid payments to health care providers, including hospitals, doctors, and caregivers.<\/p>\n In Michigan and Pennsylvania \u2014 where lawmakers have yet to pass budgets this year \u2014 spending on Medicaid is part of those debates. In Washington state<\/a>, lawmakers approved cuts to the program that will not affect who is eligible, said Hayden Mackley, a spokesperson for the state\u2019s Office of Financial Management.<\/p>\n Medicaid is government health insurance for people with low incomes or disabilities and both state and federal dollars pay for the program.<\/p>\n North Carolina\u2019s Medicaid agency announced it will institute on Oct. 1 a minimum 3% reduction<\/a> in pay for all providers who treat Medicaid patients. Primary care doctors face an 8% cut and specialty doctors a 10% drop in payments, according to the North Carolina Department of Health and Human Services.<\/p>\n Fabrello said her son\u2019s dentist already called to say the office will not accept Medicaid patients come November. Fabrello fears dental work will become another service her son qualifies for but can\u2019t get because there aren\u2019t enough providers who accept Medicaid coverage.<\/p>\n Occupational and speech therapy, nursing care, and respite care are all difficult or impossible to get, she said. In a good week, her son will get 50 hours of skilled nursing care out of the 112 hours he qualifies for.<\/p>\n \u201cWhen you say, \u2018We\u2019re just cutting provider rates,\u2019 you\u2019re actually cutting access for him for all his needs,\u201d Fabrello said.<\/p>\n Shannon Dowler, former chief medical officer for North Carolina Medicaid, said that reduced payments to dentists and other providers will lower the number of providers in the state\u2019s Medicaid network and result in \u201can immediate loss of access to care, worse outcomes, and cause higher downstream costs.\u201d<\/p>\n The imminent cuts in North Carolina \u201cdon\u2019t have anything to do\u201d with the new federal law that cuts Medicaid funding, Dowler said.<\/p>\n \u201cThis is like the layers of the onion,\u201d she said. \u201cWe are hurting ourselves in North Carolina way ahead of the game, way before we need to do this.\u201d North Carolina alone is projected to lose about $23 billion<\/a> in federal Medicaid dollars over the next decade.<\/p>\n More than 3 million North Carolinians are enrolled in Medicaid. Deadlocked state lawmakers agreed to a mini budget in July to continue funding state programs that gave the Medicaid agency $319 million less than it requested. Lawmakers can choose to reinstate funding for Medicaid this fiscal year, Dowler said.<\/p>\n \u201cWe all hope it changes,\u201d Dowler said, adding that if it does not, \u201cyou\u2019re going to see practices dropping coverage of Medicaid members.\u201d<\/p>\n Each year since at least 2019, North Carolina\u2019s Medicaid agency has asked for more money than it received from the state legislature. A variety of federal resources, including money provided to states during the covid-19 pandemic, helped bridge the gap.<\/p>\n But those funds are gone this year, leaving the agency with a choice: Eliminate some optional parts of the program or force every provider that accepts the public insurance to take a pay cut. The state opted mostly for the latter.<\/p>\n \u201cIt\u2019s a difficult moment for North Carolina,\u201d said Jay Ludlam, deputy secretary for North Carolina Medicaid. The cut in the budget is \u201cabsolutely the opposite direction of where we really want to go, need to go, have been headed as a state.\u201d<\/p>\n For Anita Case, who leads a small group of health clinics in North Carolina, the cuts make it harder to take care of the \u201cmost vulnerable in our community.\u201d<\/p>\n Western North Carolina Community Health Services\u2019 three clinics serve about 15,000 patients in and around Asheville, including many non-English-speaking tourism workers. Case said she will look at staffing, services, and contracts to find places to trim.<\/p>\n Idaho has about 350,000 people enrolled in Medicaid. This month, state leaders there responded to an $80 million state budget shortfall by cutting Medicaid pay rates 4% across the board<\/a>.<\/p>\n The broad cuts have raised backlash from nursing home operators and patient advocacy groups. Leaders of one nursing home company wrote in a recent op-ed<\/a> in the Idaho Statesman newspaper that 75% to 100% of the funding at their facilities comes from Medicaid and the cuts will force them to \u201cto reduce staff or accept fewer residents.\u201d<\/p>\n Idaho Department of Health and Welfare spokesperson AJ McWhorter said the state faced tough choices. It forecasted 19% growth<\/a> in Medicaid spending this year.<\/p>\n The Idaho Hospital Association\u2019s Toni Lawson said the financial strain will be greatest at about two dozen small hospitals \u2014 ones with 25 or fewer beds \u2014 that dot the state. Lawson, the organization\u2019s chief advocacy officer, said one hospital leader reported they had less than two days\u2019 cash on hand to make payroll. Others reported 30 days\u2019 cash or less, she said.<\/p>\n \u201cHopefully, none of them will close,\u201d Lawson said, adding that she expects labor and delivery and behavioral health units, which often lose money, to be the first to go because of this latest state reduction in payments. Several hospitals in mostly rural areas of the state closed their labor and delivery units last year, she said.<\/p>\n Nationwide, Medicaid makes up an average of 19% of a state\u2019s general fund spending, second only to K-12 spending, said Brian Sigritz, director of state fiscal studies for the National Association of State Budget Officers.<\/p>\n States generally had strong revenue growth in 2021 and 2022 because of economic growth, which included federal aid to stimulate the economy. Revenue growth has since slowed, and some states have cut income and property taxes.<\/p>\n Meanwhile, spending on Medicaid, housing, education, and disaster response has increased, Sigritz said.<\/p>\n In North Carolina, Fabrello has been unable to work outside of caring for her son. Her savings are almost exhausted, Fabrello said, and she was on the brink of financial ruin until North Carolina began allowing parents to be compensated for caregiving duties. She\u2019s received that income for about a year, she said. Without it, she worried about losing her home.<\/p>\n Now, if the state reductions go through, she faces a salary cut.<\/p>\n \u201cAs parents, we are indispensable lifelines to our children, and we are struggling to fight for our own survival on top of it,\u201d Fabrello said.<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n