The Effects of the COVID-19 Economic Downturn on Medicaid Coverage for Podiatry Services

Abstract

As of 2016, Medicaid accounted for nearly 20% of state general fund budgets. Optional Medicaid services like podiatry are often subject to cost-cutting measures in periods of economic downturn, as was the case in the wake of the 2007 financial crisis. Although the cuts were intended as a cost-saving measure, research indicates they had the opposite effect. The restriction and limitation of these services during the Great Recession resulted in both poorer health outcomes for beneficiaries, and poorer financial outcomes for state Medicaid programs. With states citing record levels of unemployment as of April 2020 and projecting significant declines in annual revenue in 2021, the economic conditions resulting from the COVID-19 pandemic are likely to rival those of the Great Recession. Given the historical precedent for restricting or eliminating optional Medicaid services as a cost-saving measure, it is likely that podiatric services will once again come under scrutiny. Previous efforts by state-level podiatric societies have proven successful in lobbying for the reinstatement of coverage under Medicaid by conveying evidence of the negative outcomes associated with elimination to stakeholders. The specialty must once again engage policymakers by drawing on evidence gleaned and lessons learned from past cuts of optional Medicaid services to avert counterproductive coverage restrictions intended to mitigate the financial impact of the COVID-19 pandemic.

Medicaid Coverage for Podiatric Care: A National Survey

“…Podiatric care is one of the optional covered benefits that states provide to varying degrees. 3 Optional Medicaid-covered podiatric services generally include nail debridement, cutting/trimming of corns or calluses, treatment of mycotic nails, and preventive services related to diabetes or peripheral neuropathy.…”

“…The clinical and economic implications of cutting services, particularly optional benefits such as podiatric care, can be substantial. 3…”

“…A growing body of research is demonstrating the relationship between Medicaid coverage for podiatry services and clinical outcomes for patients with diabetes, peripheral vascular diseases, and other chronic conditions of the foot. 3 Associated with these clinical outcomes, dramatic cost savings have been realized in the reduction of amputations and other severe clinical outcomes, and when podiatric coverage is eliminated, costs increase in the long term. For example, the Arizona legislature eliminated Medicaid reimbursement for podiatric coverage effective in 2010.…”

“…The clinical and economic implications of cutting services, particularly optional benefits such as podiatric care, can be substantial. 3 Podiatric care has been linked to improved health outcomes, reduced hospitalizations, and a lower overall cost for the health care system in general and individual patients, especially as it relates to the management of chronic conditions such as diabetes, obesity, and vascular conditions. 6,7 Preventive podiatric care such as nail debridement and treatment of calluses is particularly essential for people susceptible to foot problems and conditions such as diabetic foot ulcers, because identifying problems before they worsen is key.…”