Carla K. Johnson, AP

It's a tricky math problem to get to the $2.7 billion that Governor Pat Quinn wants cut out of Illinois's projected Medicaid spending, and four lawmakers designated to take a first shot at it will have a tough time figuring out what to subtract. They'll look at services such as the obesity surgery that helped 41-year-old Cicero resident Nova Taggart get off diabetes drugs. They'll look at payments to hospitals that are already struggling. Should people on Medicaid be able to get two pairs of eyeglasses each year? Or one pair every other year? Should poor adults get their dental care covered?

A menu of possible cuts prepared by Quinn's administration includes few dollar figures and those numbers don't add up to $2.7 billion. That's because specific dollar amounts for various options are still being calculated for the bipartisan legislative working group, Quinn senior health adviser Michael Gelder stated after the governor said Medicaid "is on the brink of collapse" in his budget address.

What's clear, Gelder said, is that lawmakers will have to choose everything on the list of possible Medicaid cuts to get to the $2.7 billion proposed by Quinn. For example, all the listed options, short of cutting payments to hospitals, doctors and pharmacies add up to only $1.9 billion, he said. Rate cuts to providers are needed to reach the target. The amount the state needs to cut "is overwhelming. It's awe-inspiring," Gelder said. "I'd say inconceivable, but we have to begin to conceive this. It's of Herculean proportion."

The list is not a proposal from the governor's office or from the Department of Healthcare and Family Services, which prepared it. "The menu of possible options does not reflect the administration's proposal; it will require bipartisan cooperation for final decision," the document dated February 22 states. The list includes some items that probably seem reasonable to people covered by private insurance plans: limiting the number of eyeglasses paid for each year, or eliminating coverage of chiropractors. The current Medicaid program has no annual limit on eyeglasses or chiropractors.

The menu includes limiting — or eliminating entirely — dental care for adults and durable medical goods, such as walkers and wheelchairs. It includes axing smaller programs for sexual assault victims, people with hemophilia and refugees who've been victims of torture. Obesity surgery is also on the list for limits or elimination.

Taggart, 41, of Cicero, had obesity surgery at University of Illinois Hospital in Chicago. The state-federal Medicaid program paid for it. Taggart paid only copayments of $2 to $5 each time she saw her doctor. She said she would have willingly paid more if she could do so over time. The surgery has eliminated her need for diabetes medication and she's lost about 15 pounds so far from her top weight of 221 pounds. She is 5-foot-2. "I hope they don't cut it," Taggart said. "I was grateful I was given the opportunity."

The list also include more drastic cuts, such as changing eligibility rules for nursing homes and at-home help so that some incontinent elderly people who can't prepare their own meals would be denied state-financed care. Today it works like this: Elderly and disabled adults are evaluated before they receive Medicaid-paid services such as help with bathing or cooking. They are evaluated using a "determination of need" score.

Increasing the cutoff score, as proposed, would mean people such as a 65-year-old incontinent woman with cataracts and arthritis who needs help with cooking and taking medications would no longer qualify for Medicaid help at home, said Carol Aronson of Shawnee Alliance in Carterville, which does such evaluations for the state. "These are not people who can care for themselves," Aronson said. "The conditions in those homes are going to be atrocious. It is going to be heart-breaking."

Also on the menu is excluding illegal immigrant children from the All Kids program. Gelder said the Quinn administration didn't want to put dollar figures on items that could become politically charged during debate. "Nobody's going to have a political ax to grind about torture victims, but they might about undocumented children," Gelder said. He continued to state that even with the listed cuts, there would remain a nearly $2 billion backlog in overdue Medicaid payments.

The list states that a nine percent reduction in payments to hospitals, doctors and pharmacies would reduce state and federal Medicaid spending by $825 million next year. A six percent rate cut would reduce spending by $550 million, according to the list. Hospitals in poor neighborhoods would be especially hard hit by Medicaid cuts, said leaders of seven Chicago safety-net hospitals.

Mark Newton, president and CEO at Swedish Covenant Hospital on Chicago's northwest side, said his facility is already operating at a $1 million loss and the state of Illinois owes the hospital nearly $10 million. With cuts to Medicaid payment rates to hospitals, the hospital would have to cut back services and reduce staff, Newton said. About 22 percent of the hospital's admissions are Medicaid patients. "This is just going to accelerate the decline to care for our vulnerable populations," Newton said. "I'm extremely worried about it."

The working group assigned to sorting out the Medicaid cuts consists of two Democrats and two Republicans, including Representative Patti Bellock. Asked whether it was possible to cut $2.7 billion, Bellock said: "It's going to have to be. If it's not, it's going to be $5.4 (billion) next year. The state is drowning in debt."