Woody MacAllister waited a long time to sign up for Medicaid.
“Got to Juneau, people at Front Street Clinic kept bothering me and bothering me, to sign up for Medicaid,” he said.
MacAllister is homeless and lives in downtown Juneau. When he finally signed up for Medicaid, the government-funded health insurance program for low-income people, he was told that he was eligible for dentures, “uppers and lowers,” MacAllister called them.
“So we started to go through that process, and they pulled out 11 teeth at one time. I had to wait five months for my mouth to heal.” After five months he started to have the molds made for the dentures. “They just stopped,” he said. “Adult dental got shut down.”
The reason? “Governor,” he said. “There’s no money any more.”
This was back in July, when Gov. Mike Dunleavy first announced $444 million in cuts to the state budget, including $50 million for Medicaid.
MacAllister, like many Alaskans, was left in limbo and unable to get a clear answer about if or when his services would return.
After two special sessions of the state Legislature, failed override votes and a lot of waiting, the dust has finally settled, for now, around the state’s budget for 2020.
After the Legislature sent two funding bills the the governor’s desk, the $50 million in cuts to Medicaid remained, as well as $27 million for adult enhanced dental services covered under that program.
Quite how those cuts are going to affect the state are not yet clear. Medicaid is administered by state governments, but the federal government requires that certain services, such as emergency room visits and obstetrics, be covered.
Dental services are an optional service states can elect to offer, and while Alaska will still cover emergency dental procedures, preventative dental for adults has been unfunded since July 1, according to the state’s Medicaid handbook.
Chuck Bill, CEO of Bartlett Regional Hospital told the Empire in an interview Thursday that the hospital was still uncertain as to how the cuts would take shape.
“We don’t really know how (the cuts) are going to be implemented and how that’s going to affect the hospital,” he said.
Chuck Bill, CEO of Bartlett Regional Hospital, in his office on Thursday, Aug. 22, 2019. (Peter Segall | Juneau Empire)
Bill said that the Department of Health and Social Services, which administers Medicaid for the state, has announced a 5% cut in rates.
“That will impact us about one-and-a-half million,” Bill said.
Health care providers are reimbursed by state Medicaid programs which determine which services are covered and how much they will pay for services.
The hospital doesn’t make much money from Medicaid patients. The hospital makes more money from patients with private health insurance but that source of income may be threatened by cuts to the state government as well, Bill said.
“The other piece that’s going to be a big impact on the hospital is what (the budget) is going to do to local jobs,” Bill said, “how many local jobs are going to be lost to the community.”
Given the large number of public employees in Juneau, Bill speculates that the downsizing of the state government might have a disproportionate impact on the city.
“If a lot of people end up leaving town or moving from insured jobs to Medicaid, neither one of those options is great for us,” he said.
Bill said that approximately 30 percent of the hospital’s patients were covered by Medicaid. But Bartlett also administers behavioral health programs, which faced a cut of $6.1 million. Bill estimates that 90% of those patients are covered by Medicaid.
While the hospital is bracing for a significant reduction, Bill said that he doesn’t anticipate having to reduce staff.
“We may, by attrition, not fill some positions over time,” he said.
The hospital may offer fewer services, Bill said, adding that “we are looking at our productivity to ensure that the services we are providing are functioning as well as they can.”
Because Bartlett has other sources of income, Bill said that the hospital was able to finish to most recent financial period with a $3 million bottom line.
But Bill was cautiously optimistic about the hospital’s future.
“I think it’s important in this time of turmoil that people not panic,” he said. “Things have a way of working themselves out. From a hospital stand point a million and a half dollars is a lot of money but we can figure it out.”
Crouched in a doorway in downtown Juneau, MacAllister expressed a mix of anger and confusion. Not at his own predicament, but at the situation generally.
“I’m just wondering what kind of stuff is happening to other people,” he said. “Now granted, I’m a bottom-feeder, dentures aren’t a super life-saving thing. Dental is one thing, but medical procedures that you need to get? That’s the question I want to ask. Did you even think about the repercussions it would have on other people?”
• Contact reporter Peter Segall at 523-2228 or psegall@juneauempire.com.
