Eye exams and glasses for adults on Medicaid will be the first casualties in the new cuts to health services for North Carolina's poor. The aid cuts are due to start in October.
Medicaid recipients are receiving notices about reductions, eliminations or other changes to an array of health services in the next few months.
The $354 million Medicaid cut in the state budget includes limits and other changes to services, totaling $16.5 million.
In addition to getting rid of routine adult eye care and glasses, the state plans to limit payments for deep-cleaning dental treatments for people who have gum disease to once every two years from once a year. Outpatient physical therapy, occupational therapy and speech therapy for adults will be limited to three visits a year.
The Medicaid service reductions were included in Gov. Bev Perdue's proposed budget and adopted by the legislature. More health-care limits may come as the state Medicaid office looks for more savings in the program.
"They may seem like innocent cuts on the surface, but cumulatively, they are likely to lead to higher health-care costs later and potentially the loss of independence for many residents," said Richard Gottlieb, president of Senior Services in Winston-Salem.
For example, Gottlieb said, people with poor or uncorrected eyesight are at greater risk for falling. Poor eyesight also can contribute to hallucinations for people experiencing dementia, he said.
"For the homebound, being able to read their newspaper or their Bible is important to them," Gottlieb said. "A lack of dental care could contribute to poor nutrition."
As word gets out about the state funding cuts, Gottlieb expects Senior Services and other care providers will be inundated with calls.
"I don't believe the efforts are being very cost-effective, and certainly can wind up hurting those who perhaps can stand it the least," he said.
Lanier Cansler, state secretary of health and human services, said the department looked for the least-damaging options for cuts.
"It's obviously a consideration and a concern," he said. "When we have to control the Medicaid budget, we try to do the things that have the least damage on health. It's a tough decision. The governor doesn't like them, we don't like them."
The department will likely need more service cuts to hit its budget targets and is formally gathering suggestions on ways to extract an additional $32 million to $118 million in state costs from the government health-insurance program.
The state and federal governments pay for Medicaid. For every $1 the state spends, the federal government spends $2, meaning that the state will spend about $1 billion less on Medicaid this year than last year.