sold under a manufacturer's brand name. The only exceptions are prescriptions for children or when the doctor specifically states on the prescription that it is to be filled only with a certain brand with no substitutes allowed. The profit on the lower-priced drugs would be lower, of course. Since pharmacy economics are pegged to the doctors' habit of writing the vast majority of their prescriptions by brand name, rather than generic, the rule could eat heavily into pharmacy profits. Medicaid officials say they're sympathetic but they've got to hold down medicaid costs as much as possible. By far, the most immediate storm, however, is raging over the payment of doctors, dentists and pharmacists for medicaid patients. Because medicaid was put into effect by the state so swiftly, with little preparation, the city welfare department had neither the manpower nor the procedures to pay the flood of bills that started pouring in. City welfare officials say it will be late this summer, 15 months after the program became effective, before they will have the automated processing equipment available to pay medicaid bills within 60 days. Meanwhile, unpaid medicaid bills are piling up. The department says it is desperately trying to pay at least 50% of the amount of each bill immediately, without processing; the remainder is paid after fiscal auditing of the bill. Despite this, "I know doctors who say they haven't gotten a single cent from medicaid yet," says Dr. Himler. This is especially hard on physicians practicing in or near slum areas. He notes that one doctor near Harlem, 95% of whose patients are now medicaid patients, has received little or nothing from the program for months. A dental society official cites the complaint of a Harlem dentist with an office that handled 50 patients one day recently. "Only four of them were private paying patients, the rest were medicaid for whom he won't be paid for months," he says. "You can't make a living on four patients a day." Moreover, while the dentists wait for medicaid payments, their expenses for dentures, orthodontic equipment, filling material, X-rays, nurses, receptionists and rent continue. At one point, some desperate physicians started selling their unpaid medicaid bills to a factoring concern at 90 cents on the dollar. This ceased when the welfare department said its payments could go to no one except the doctors. Medicaid seems to have created the least problem with the city's prepaid group health plan, Health Insurance Plan of New York. Members of HIP pay a monthly fee for which they receive all medical care from the plan's network of clinics around the city. For medicaid enrollees who so specify the program will pay HIP $5 a month for an individual, $10 a month for a couple and $15 a month for a family. HIP, in return, provides full physician and clinic services with no further billing of medicaid. So far, more than 60,000 medicaid eligibles have chosen HIP (it has a total membership of 755,000). The only difficulty, say HIP officials, is that some of the plan's clinics have reached their capacity and have had to stop medicaid enrollment temporarily until more physicians can be hired. NEW YORK CITY POSITION The city, meanwhile, is pushing to get as many persons enrolled in medicaid as possible, despite the difficulties in trying to get the program off the ground. One major reason is that the influx of Federal and state medicaid money is taking over a major share of the cost of the city's burgeoning expenses for medical care for the indigent. In fiscal 1966, Assistant Welfare Commissioner Henry J. Rosner recalls, the cost of medical care for the indigent, including expenses of the welfare, hospitals and health departments, ran more than $426 million. The city had to pay more than half of this, or $260 million, out of its own tax revenues. In the current fiscal year, the bill for such medical care is expected to zoom to $747 million. But, as a result of medicaid, Mr. Rosner explains, the Federal Government will pay about $200 million and the state will pay more than $228 million. The city's share will amount to slightly more than $317 million, or less than half the total cost. "Our expenses have been going up by leaps and bounds," Mr. Rosner says, as a result of both rising costs and broadening services. If it hadn't been for the state and Federal medicaid funds, he says, "the burden would have been too great for the city." There are signs that medicaid is accomplishing its purpose of eliminating "charity medicine." In an attempt to encourage enrollment in medicaid, city hospitals have eliminated free services in their outpatient clinics and emergency rooms. Where care once was free to anyone walking in, the patients now must either pay $8 a visit or show a medicaid card. The city, of course, bills medicaid for the latter patient. ITEM 6: ARTICLE FROM THE LONG ISLAND PRESS, SEPTEMBER 21, 1967 THREAT TO 900,000 SEEN IF MEDICAID IS RESTRICTED (By Richard F. Long) The New York State Commissioner of Social Services yesterday said if Congress should pass restrictive legislation in regard to Medicaid, about 900,000 New Yorkers would not be eligible for the free medical services in 1970. George K. Wyman, the commissioner, testified before the Senate Finance Committee, which is holding hearings on amendments to the Social Security Act. The House Ways and Means Committee amended the act to limit Medicaid to persons whose incomes are 33 per cent above state welfare limits. "This proposal," Wyman said, "seems utterly unrealistic to us in New York State. It is unrealistic because it proposes to reduce the eligibility standard at the same time the cost of medical care is escalating at a very rapid rate." Under the current state-federal Medicaid program a New York State family of four with a net income of $6,000 would be eligible to receive a variety of free medical services. Some officials have indicated that if the restrictive legislation is passed, the New York limits could drop to $1,000 or $2,000 for a family of four. Wyman said the gradual reduction of federal participation the amendments call for could render ineligible 900,000 New Yorkers by 1970. Wyman was the third prominent New Yorker to criticize the Medicaid restrictions before the committee. Sen. Jacob K. Javits and Sen. Robert F. Kennedy have also voiced objections. The commissioner said that if the restrictions are passed, the expenditures on the program will be reduced by $150 million by 1970. "The reason for this very substantial reduction," Wyman said, "is that when one federal dollar is eliminated from the program, one matching state and one matching local dollar are also reduced. Therefore the real impact of the federal reduction will be tripled." The Senate Finance Committee is expected to finish hearings on the amendments soon. The amendments bill will then go to the floor of the Senate for a vote. The bill, including the restrictive amendments, has already passed the House. ITEM 7: THE WILLIAM HODSON COMMUNITY CENTER-A DAY CENTER FOR OLDER PERSONS "Hodson Center is the triumph of a vision-a place where our older citizens engage in fruitful work, where they develop their talents, where they pursue their education and partake of recreational facilities."-Mayor Robert F. Wagner, Dedication Ceremonies, September 22, 1964. In 1943 staff members of the Department of Welfare saw the need for a place where older people could be together other than in welfare or clinic waiting rooms. They started Hodson Center, and it became the first Day Center for older people in the world. Today Hodson Center is operated by the New York City Department of Welfare. We are located in Claremont Village, a complex of four public housing projects built by the New York City Housing Authority. Staff is provided by both of these agencies and augmented by the Board of Education, the Health Department, and by salaries from private funds raised by the Board of Directors. We recognize that the varied needs of older adults require diversified skills. Specialists give expert supervision to groups, and guidance to individuals. All of our staff is sensitive to the special problems created by age and retirement. Some of our members need services entirely new to them. Others simply want the assurance of a warm reception in a friendly place. After the staff implemented the idea of the Center, a Board of Directors was incorporated, and later the Women's Auxiliary was created as a volunteer corps. Today the Auxiliary manages and staffs the Thrift Shop, helps with birthday and holiday parties, and has representation on the Board of Directors. The Board of Directors cooperates with the city agencies to set policy, and has often initiated features which have been continued by the public agencies— our music program, the addition of an occupational therapist, and the cafeteria. The Board raises funds from the community to enrich the program, and has made possible the many pilot projects for which Hodson is famous: the first "camping" for older people, the first student training in gerontology, a nationwide television show filmed at the Center, a widely distributed film strip about day centers, and the planning of the building in which we now operate. Many members of the Board are also volunteers-in the office, in planning publicity, or with the members. Every dollar the Board raises is augmented by the service it gives! All people want to be helpful to others, but older citizens are often deprived of the opportunity due to loss of former contacts, lack of mobility, economic deprivation, or simply the inability to find an outlet. Some members find satisfaction in helping others at the Center. Our barber shop, cafeteria service, and repair work grew from this need. Other people, because of their past experience or ability, provide leadership in program planning, guidance to the membership council, or act as hosts to visitors. Our members also serve the broader communty. Sometimes they work at the Center, rolling bandages and converting shirts into hospital gowns, making toys for nurseries, or creating articles for sale. Other services are arranged outside the Center; visiting the homebound or those in hospitals, and entertaining at public schools and homes for the aged. An experimental project is under way to find other opportunities in the community for volunteer work. The results will be published and made available to day centers throughout the world—another pioneering effort! Hodson Center has 1100 members, men and women over 60 and usually under 90! A large number find satisfaction and relaxation in developing skills; some pursue old hobbies or trades, while others find completely new fields of creativity. Materials and machinery are available for our staff to offer expert instruction in ceramics, woodworking, sewing, painting, weaving, sculpture. Sometimes a member's own interest starts a group and teaches the staff-a stamp collector or a photographer! But facility alone is not as important as the effect a "mere" hobby can have on emotional well-being. This is dramatically apparent when a piece of work stimulates the surprised admiration of children or grandchildren. Or when an object is sold for the benefit of the Center. Or when visitors admire a one-man show in the corridors. Music is an important part of our program because, of all the arts, it provides the greatest variety of satisfactions. Some of our members study instruments, some sing solo parts or in choral groups, some play in the orchestra or rhythm band. And everybody sings! Education is pursued in many ways at Hodson Center. The Board of Education supplies an English teacher, since many of our foreign born members never had time to learn to read and write English. This class often supplies some of the material for our monthly publication, "Hodson Voice," which is written, illustrated, and distributed by the members. The Department of Health provides public health nurses to give advice and instruction on an individual basis. Nutrition classes supplement health information, and our cafeteria serves a balanced meal each day for about 30¢. It would be hard to find a place of interest in New York City that our Trip Group has not visited. The broadened horizons of those who are able to travel stimulates the discussion groups for those who are not so agile. Topics vary, from Current Events to Family Living or perhaps Poetry. The knowledge gained is often secondary to the give-and-take of a group experience, so important to those who are deprived of being with others by retirement and old age. The facilities are indeed available at Hodson Center: a pool table, cards, shuffle board, outdoor game tables, film projectors, television-even a garden. But facilities are only tools, and their value is as varied as the individuals who use them. We know that our American society has favored work and youth—understandable for a young nation with frontiers to open and industry to build. But today lengthened years, shortened hours, a growing population, and an expanding economy are creating new attitudes toward aging and retirement. Above all our approaches to leisure must be re-examined, and this generation must set patterns for its use. Sometimes people have to be taught to enjoy themselves? At Hodson Center we are just beginning to grasp our role in this changing world, and appreciate that programs such as ours will slowly teach the generations, one by one, that a human being's days on earth will not only lengthen, but can broaden as well. О |