State backtracking on Medicaid cuts in proposal to U.S.

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HARRISBURG -- Chiropractic coverage and visits to podiatrists and optometrists, which Gov. Tom Corbett's administration had proposed eliminating from the state's Medicaid program, could be preserved after all.

The proposed changes are part of Healthy PA -- a major overhaul of the state's Medicaid system that includes some benefit cuts, as well the governor's plan for 500,000 poor Pennsylvanians to purchase private insurance through using federal subsidies, rather than through an expansion of the state's Medicaid program.

Friday marks the end of a federal comment period on the plan; many aspects of what the state is proposing require federal approval.

More than 2.2 million people -- about 1 in 6 Pennsylvanians -- are enrolled in Medicaid.

Under federal law, certain types of medical services -- including chiropractic, podiatric and optometric services -- are optional for states to include in their Medicaid coverage, said Laura Snyder, a policy analyst at the Kaiser Family Foundation. The proposal Pennsylvania submitted to the federal government in March lists these services as "not covered."

State Department of Public Welfare officials said no changes have been made to the state's plan, but several sources said coverage of these services is written into state law.

"We're not an optional service in Pennsylvania," said Michael Davis, executive director of the Pennsylvania Podiatric Medical Association.

A number of the more than 600 public comments on the Centers for Medicare & Medicaid Services website takes issue with the proposed exclusion of such services, noting in particular that optometric and podiatric care is critical for people with serious diabetes.

Some commenters identified themselves as chiropractors and said the care they provide is a cost-effective alternative to surgery or painkillers.

"We are aware of the issues addressed by the associations [of chiropractors, podiatrists and optometrists] and have been in conversation with them," Kait Gillis, a DPW spokeswoman said Wednesday. "While no modifications have been made to the plan to date, their comments will be addressed in the formal negotiation period [with the federal government], beginning April 11."

A letter submitted by the Pennsylvania Podiatric Medical Association in support of Healthy PA requests "that discussions between the Centers for Medicare & Medicaid Services (CMS) and Corbett Administration continue thereby ensuring that services provided by podiatrists remain allowable in the Pennsylvania Medicaid program."

Anthony Geramita, a chiropractor with offices in Lawrence and Mercer counties who has a number of Medicaid patients, said he was "astonished" when he learned the state had proposed eliminating chiropractic coverage for Medicaid enrollees.

"I don't know why it was put on the chopping block," said Dr. Geramita, a board member of the Pennsylvania Chiropractic Association.

Kate Giammarise: 717-787-4254 or or on Twitter @KateGiammarise.

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