RD328 - Report on Medicaid Coverage of Podiatry Services - November 2010


Executive Summary:
The 2010 General Assembly, in response to a state budget shortfall, proposed the reduction or elimination of various Medicaid services in order to cut costs. As part of this effort, the General Assembly directed the Department of Medical Assistance Services (DMAS) to amend the State Plan for Medical Assistance to remove coverage for services provided by podiatrists on July 1, 2011. The General Assembly also directed DMAS to “review available data from other state Medicaid programs that have recently eliminated coverage of podiatry services and evaluate the impact on other Medicaid costs of eliminating this service”. This directive is provided in Attachment 1.

The General Assembly also indicated that if the Federal Medical Assistance Percentage under the American Recovery and Reinvestment Act was extended through June 30, 2011, the Governor had the authority to direct how the various reductions in appropriations (such as the removal of services provided by podiatrists) were restored. At the time this report was written, the funding for podiatry services had not been restored. DMAS estimated that eliminating services provided by podiatrists would save the state $430,950 in General Funds.

The General Assembly’s directive calls for the removal of Medicaid coverage of a type of provider (podiatrists)—not the services themselves. The services currently provided by podiatrists can be provided by orthopedists or other providers. In practice, however, most of the primary services provided by podiatrists would not be provided by other medical professionals.

Podiatrists provide essential foot care to diabetics and other patients at risk for lower extremity complications (LECs). This primary care plays a critical role in preventing foot ulcers, which, if left untreated, can lead to greater complications and even amputations. Eliminating coverage of services provided by podiatrists might save a little money in the short run, but treating the resulting complications would undoubtedly lead to higher costs for the Medicaid program in the long run.

This report is being submitted to the Chairmen of the House Appropriations and Senate Finance Committees in response to the General Assembly’s directive. The report addresses the following topics: 1) podiatry services in general, 2) Medicaid podiatry services in Virginia and in other states, 3) data from another state that briefly eliminated coverage of podiatry services, and 4) the impact on Medicaid of eliminating podiatry services.