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From The Roanoke Times

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As state lawmakers consider cutting millions from Medicaid, more Virginia children and adults are seeking health insurance coverage through the program.

Statewide enrollment for Medicaid services was up 4.8 percent to 692,049 in December from 660,642 a year earlier, according to the Virginia Department of Medical Assistance Services.

Enrollment in the State Children's Health Insurance Program, called Family Access to Medical Insurance Security in Virginia, was up 11.4 percent from 86,667 in December 2007 to 96,511 a year later.

The uptick in Virginians seeking government-provided health insurance comes as more people meet the income qualifications because of layoffs or reduced hours, social workers and applicants have said.

At the same time that the global economic crisis has forced Virginia to face budget shortfalls, it has also led more people to seek social services.

"This is exactly what Medicaid is expected to do," said Chris Bailey, senior vice president of the Virginia Hospital & Healthcare Association. "It grows precisely in environments when state environments are at the worst."

Even with the commonwealth's already extra-lean Medicaid program -- 47 states spend more per capita on Medicaid than Virginia does -- the program accounts for one of the largest portions of the state budget, making it an obvious target for cuts.

During his annual address to state lawmakers last week, Gov. Tim Kaine said he recognized the dilemma.

"In proposing this budget, I was acutely aware that precisely at the time the state is trying to balance our budget, more Virginians are in need of the safety net that Medicaid and other agencies provide," he said.

"My proposal makes cuts without taking Medicaid coverage away from anyone who is currently covered. But the decisions to get there were not easy."

Kaine proposed capping enrollment for certain programs, freezing or reducing provider reimbursement rates and delaying expansion of other services.

In total, Kaine's proposed budget cuts Medicaid funding by $418 million.

In Roanoke, Medicaid enrollment figures for December increased by 6.4 percent, a sharper increase then the state average.

Roanoke and Montgomery counties saw their respective December Medicaid enrollment figures increase by 3.7 percent and 2.4 percent from 2007 to 2008.

Lines have become commonplace at the Virginia Department of Social Services offices in Roanoke, as record numbers of people seek assistance this winter, Director Jane Conlin said.

On Jan. 5, a record 765 people came through the department's doors on Williamson Road. The previous record was set on the Monday after Thanksgiving, when 550 people sought help.

Even after Jan. 5, which was the Monday after the New Year's holiday, the numbers of people looking for services have continued.

"The first week in January we had over 2,100 people come into our office," Conlin said. "I mean, that's a record."

Not everyone showing up at the Department of Social Services is looking for health insurance. Food stamp requests are up about 10 percent, and the fuel assistance program has also met high demand, said Bruce Stultz, the chief of benefit programs and employment services at the department's Roanoke office.

"I think people have lost jobs, and so more people are needing help with coverage," Stultz said. "Most of my staff would say it's just hard times."

Larry Lindsey, director of the Montgomery County Department of Social Services, said the increase in applicants has put a strain on his staff.

"It really puts us in a crunch, trying to meet the demand with the resources that we have," Lindsey said. "It's quite a challenge."

While December Medicaid enrollments were up slightly from the previous year in Montgomery County, enrollment in FAMIS rose 18.5 percent.

In Roanoke, enrollment in the children's program rose 8.7 percent between December 2007 and December 2008. In Roanoke County, the number rose by 6.5 percent for the same time period.

Angela Bobbitt, who enrolled in the Medicaid program at the DSS office in Roanoke about a year ago, said it is a challenge to find doctors who will treat her and her children.

"Medicaid itself is a joke," Bobbitt said. "The system is a joke. You're insured. It's great on prescriptions. But first you have to find a doctor who will take the Medicaid. In my experience and what I have found, doctors don't want to deal with Medicaid."

Because the program reimburses physicians at low rates, they often limit the number of Medicaid patients they see, arguing that if they didn't do so, they would be put out of business.

Hospitals, which also face rate cuts for Medicaid patients, are not allowed to limit the number of Medicaid patients they see. And in poor economic times, Bailey said early anecdotal evidence suggests that hospitals are already seeing more Medicaid clients as well as more uninsured patients.

About 40 percent of a hospital's business is paid for through Medicare -- 15 percent through Medicaid; 5 percent to 10 percent through charity care -- never reimbursed -- and the rest is paid for through private insurance, Bailey said.

In rural hospitals, 75 percent to 80 percent of services are rendered to Medicare or Medicaid patients , he said.

"If this trend continues or accelerates, and the economy continues to suffer and we get more rapid growth in enrollment, then the impact of the cuts to hospitals will be worse," Bailey said.