Optional Medicaid benefits face state cuts

— -- States are using a variety of strategies to control rising Medicaid costs even as they look ahead to a massive expansion of the state-federal health insurance program for the poor beginning in 2014.

The weak economy is driving more jobless Americans into Medicaid, increasing enrollment at the same time that medical costs keep going up.

To deal with the higher costs, states are pushing Medicaid recipients into managed-care plans run by private insurers, cutting reimbursement rates to hospitals and doctors and reducing benefits.

The new federal health law requires states to maintain Medicaid eligibility and enrollment standards until 2014, when the expansion begins to add 16 million Americans to the program. States are still free, however, to cut optional benefits, which include drugs, vision care and visits to certain providers such as chiropractors and podiatrists.

Within those restrictions, many states have enacted benefit cuts in fiscal 2012.

This month, Nebraska began limiting how many adult diapers it pays for to 180 a month. In July, Colorado stopped covering circumcisions. Tennessee ended coverage of adult acne medicine.

Other steps:

•California plans to eliminate adult day-care coverage and limit Medicaid patients to seven doctor visits a year, as of November.

•North Carolina this month stopped covering regular eye examinations and eye glasses for adults in Medicaid.

•Connecticut in July cut the number of dental exams covered for adults in Medicaid from twice a year to once a year.

•Pennsylvania began requiring adult Medicaid patients to get state permission for crowns and certain other dental procedures.

"The benefit cuts are indicative of the real cost pressures on states and that there are only so many things you can do to address them," said Stacey Mazer, senior staff associate at the National Association of State Budget Officers.