500,000 adults in Washington could lose prescription-drug coverage

Some 500,000 Washington adults whose prescriptions are covered by Medicaid could soon lose that benefit unless lawmakers provide special funding when they reconvene in January.

Medicaid's adult drug program, which provides medication to the state's poorest individuals through a combination of state and federal funding, will be eliminated in March if the Legislature can't come up with $40 million before Feb. 1, according to the Department of Social and Health Services (DSHS).

Washington would be the only state to eliminate the program, according to Pharmaceutical Researchers and Manufacturers of America, an industry group in Washington, D.C.

For Doug Porter, the state's Medicaid director, losing the program would be "beyond painful."

"This is not why I came to public service," Porter said.

In September, Gov. Chris Gregoire ordered a 6.3 percent cut in all state services to cope with an expected $1.4 billion budget shortfall. To meet this mandate, DSHS says it will need to trim $280 million from its budget, including about $110 million from the Medicaid programs it administers.

The adult-prescriptions program cannot be protected in the DSHS cuts because federal law requires states to maintain many other Medicaid benefits, Porter said. Those federally required benefits include pharmaceutical coverage for children and prescriptions dispensed in health-care facilities such as hospitals and nursing homes.

Porter said the department has to eliminate every optional service to meet the governor's order.

Gregoire had no choice but to issue the across-the-board reduction, because legislators refused to hold a special session this year to make targeted cuts, said Karina Shagren, a spokeswoman for the governor.

Consequently, lawmakers will have three weeks after they return to arrange special funding and save certain projects from the chopping block.

"She's asking them to tackle a supplemental budget as soon as they return," Shagren said. "So rather than forcing Medicaid programs to take the same cut as, say, our tourism program, she's asking them to take a look at what needs to be saved."

State Rep. Tom Campbell, R-Roy, a chiropractor and member of the House Health and Wellness Committee, said he is determined to ensure the program survives but cannot guarantee it in the current political and economic environment.

"This is seriously playing with fire," said Campbell, who supported a special session that would have prevented the governor's categorical cuts. "We're going to have to work very hard to undo this stuff as quick as possibly."

For other legislators, no program is safe from cuts, given the state's budgetary woes. "Everything's going to have to be on the table, but obviously we're going to have to look at the core priorities and make sure the most vulnerable are protected," said state Sen. Rodney Tom, D-Bellevue.

For Charlie McCary, 48, a Kennewick woman, losing Medicaid drug coverage would end the stability she's attained since she was diagnosed with several forms of mental illness seven years ago. She said she takes more than a dozen Medicaid-covered drugs to treat post-traumatic stress disorder, bipolar disorder and depression.

Without medication, her life would fall apart, she said, and maintaining jobs, friendships and sanity would be impossible.

"One year, I got fired five times before I was on the right medication," said McCary, who has successfully worked part-time secretarial jobs since starting treatment.

Campbell said part of the solution could be making the eligibility standards more selective. Washington's standards are more generous than the federal minimum.

Porter suggested the state might take money from other agencies, such as the Health Care Authority, which administers health-care coverage for state employees and some low-income Washington residents. It has a budget surplus, said Porter, who heads that agency along with the state's Medicaid programs.

State officials and industry experts share a concern that eliminating the adult pharmaceutical program might end up costing the state more money than it saves.

Some Medicaid clients, for instance, may turn to hospital emergency rooms or move into nursing homes to obtain prescription coverage, which would cost the state more than a Medicaid-covered prescription would, they said. Other Medicaid clients might stop taking their meds, worsening their conditions and possibly leading to costly emergency-room visits. The risks are greater for people with mental illnesses, officials said.

Though Washington would be the first state to eliminate adult coverage, other states have cut coverage.

In the mid-1980s, when New Hampshire limited each Medicaid client to three prescriptions at any one time, the state's drug-coverage costs decreased 35 percent, but nursing-home admissions increased 60 percent, according to The New England Journal of Medicine.

The state's costs could increase even more for patients who don't find other methods to get drugs, said Marjorie Powell, who studies public policy at Pharmaceutical Researchers and Manufacturers of America. "If I have a heart condition and I don't take my medicine, I'm going to end up sicker and I could have a heart attack," Powell said. "It doesn't save money even in the short term."

And mentally ill people who stop their meds could end up in the hospital or in custody, said Gordon Bopp, chairman of the Public Policy Committee at the Washington chapter of the National Alliance on Mental Illness.

"They'll have psychotic episodes, and they'll wind up getting arrested and put in jail," said Bopp, who has two daughters who suffer from mental illnesses and are covered by Medicaid. "That wouldn't save the state anything at all."

McCary, the Kennewick woman, said she knows what will happen to her without Medicaid coverage: "I would be hospitalized."

Sean Collins Walsh: 206-464-3195 or swalsh@seattletimes.com