Patients urge lawmakers to change Alabama’s Medicaid caps on visits and prescriptions

HUNTSVILLE, Ala. (WAFF) -Viewers from across North Alabama told WAFF 48 that strict Medicaid limits on doctor visits and prescriptions are putting their health at risk, and they want lawmakers to step in.

In Alabama, many Medicaid patients are limited to 14 doctor visits a year and about five prescriptions a month.

Some recipients said those caps force them to “pick and choose” which health issues to treat and when.

Several viewers told WAFF 48 that once they hit those limits, they have to pay the full cost of treatment out of pocket.

For people who qualify for Medicaid because of financial need, that’s often not possible.

Jessica Finch has been on Medicaid since she was 15.

Due to her epilepsy, she said she needs more than 14 doctor visits a year to manage her condition.

She also said she has paid out of pocket for tests she needed before a brain surgery scheduled for this Friday, because they were not covered.

On top of that, she rations her medication every month because she’s only allowed a limited number of prescriptions.

Another viewer, Christina Guzman, said the caps affect her entire family.

She and her three children have been on Medicaid for more than 15 years.

Guzman said she often has to decide which health issue is most urgent because she and her children only get so many visits a year.

“Some of our visits are having to pick and choose on what doctors we see, what health issue is more concerning at that time, because you only get so many a year,” Guzman said.

Guzman said these limits don’t just affect basic checkups, they’ve delayed major procedures she needs to stay mobile.

“With my hips… I’ve only been able to do one surgery a year,“ said Guzman. ”I feel like that has set me back and made it worse. Right now, I need to have a hip replacement and I’ve put it on hold because of how many visits I’ll have taken away.”

She said she worries about what skipping care now could mean for her future and her ability to care for her kids.

“It’s frustrating,” said Guzman. “It’s scary because you don’t know if skipping that appointment is going to affect you and your health. You’re being told that if you don’t have these visits or these surgeries, you’d be put in a wheelchair and not be able to walk. And that’s in my case.”

Guzman said that while she’s grateful for Medicaid, the caps make it hard for her family to get all the care they need.

“I have seen people have died from not being able to see their doctor or because they used up their visits and they couldn’t get their medication because they couldn’t afford it or because Medicaid doesn’t cover it,” Guzman said.

Advocates say older Alabamians are also feeling the impact.

“When you are capped at just 14 visits a year and you’re in an age group, 50 to 64, that is much more likely to have one of these conditions, it creates some barriers for folks to access care that they need,” said Jamie Harding, communications director for AARP Alabama.

Harding said strict limits on visits and prescriptions can lead people to delay treatment or ration their medications.

In some cases, she said, patients turn to the emergency room when they can’t see a regular doctor.

Harding said when people use up their appointment limits, “they are going to be much more likely to end up in the emergency room seeking primary care there.”

Under Alabama’s current rules, there are no similar caps on emergency room visits for Medicaid patients, but the ER is often the most expensive place to get care.

“Emergency departments should be for emergencies only, and they shouldn’t have to deliver primary care to folks who just don’t have access to it,” Harding said.

Harding said Medicaid is “the backbone” of Alabama’s healthcare system, supporting children, pregnant women, and seniors in institutional care.

She does want to see changes to the number of visits and medications people can receive.

In 2023, a new rule went into effect, allowing diagnosed cancer patients to visit the doctor 32 times a year.

A big increase from the standard 14.

Harding said that change shows the system is flexible.

“If they can change the rules around cancer treatment, that means they can be changed for other things as well,” Harding said.

She noted that many adults ages 50 to 64 live with other chronic illnesses, like diabetes, arthritis, and heart disease, but don’t get the same flexibility in the number of visits.

“Not all states have these kinds of caps,” Harding said. “A lot of states don’t. They don’t say you can’t have as much care as you need when you need it. So Alabama, this is very much a way for them to try to contain costs.”

Harding said any change to visit or prescription caps has to come from lawmakers, because Medicaid rules are set at the state level.

“Our legislators pay attention to the folks who get in touch with them the most,” said Harding. “If they don’t hear from you, then they don’t think you have a problem.”

WAFF 48 reached out to a lawmaker who sponsored Medicaid bills this session to ask if there are any plans to change the caps, but did not hear back in time.

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