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Bipolar News

August 30, 2005

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Audit underway of state medical examiner's office
Boston Globe - United States
... Allen, a war veteran with bipolar disorder who lived with his mother in Cranston, was found dead at home morning in October 2003. ...

Some Returning Veterans Face Obstacles in Resuming Their Lives

Some veterans of military service duties in Iraq and Afghanistan are facing difficulties in resuming their lives once they return from overseas. Two extreme examples include former soldiers honorably discharged from Iraq who had trouble adjusting to civilian life due to PTSD symptoms, according to their families. Based on separate incidents in different parts of the country, the two have been arrested and charged with attempted murder and murder, in one case, and attempted murder, in the other case. Many of these veterans have been "immersed in a brutal environment" in Iraq and Afghanistan and are then "dumped back home among people who don´t understand," said a Stanford University psychiatrist. Many veterans, who might otherwise seek counseling, don´t due to stigma. (Intellihealth/The Associated Press, 8/22/05) (Intellihealth/The Associated Press, 8/22/05)

South Carolina Medicaid Plan Has the Potential for Widespread Changes

If approved, South Carolina´s Medicaid proposal being considered by the federal Centers for Medicare and Medicaid Services (CMS) has the potential for dramatically changing how the state - and other states - provide Medicaid services to people who have low incomes. South Carolina officials argue that the current Medicaid system does little to encourage frugality in seeking medical services. The state´s proposed solution would be to create accounts for each Medicaid recipient - the amounts for which will depend on age, gender and disability status - through which each recipient will purchase insurance coverage through private companies. The costs of any services above the amount in individuals´ accounts would be the responsibility of the individuals. Other states are watching to see if CMS approves the plan, experts say. (Dow Jones Newswires, 8/16/05)

State Finances Improve During FY 2005

State finances improved significantly during fiscal year 2005, bolstered by unexpectedly strong revenue and fiscal assistance from the federal government, the results of a survey released at the National Conference of State Legislatures annual meeting last week indicates. Of the 46 states that responded to the survey, 29 percent reported that revenue grew by more than 5 percent during the fiscal year. Of all the states, revenue grew by 6.8 percent during the year. General fund spending also increased by 6.8 percent during the year, largely due to increased Medicaid costs. (Dow Jones Newswires, 8/18/05)

State News

Minnesota: American Indian tribes in Minnesota have joined together to start the Native Youth Crisis Hotline in an attempt to help stem the suicide rate among American Indian youth, which is three times higher than other ethnic groups among 15- to 24-year-olds. Almost $40,000 has been spent on developing the crisis line, which will be administered by the Women of Nations, a group that supports battered women and has a crisis line. (Intellihealth/The Associated Press, 8/18/05)

New Hampshire: A panel established to examine why the state has lead the nation in per capita distribution of the ADHD drug Ritalin has concluded that, compared to national norms, the state doesn't have a greater-than-expected number of children diagnosed with ADHD or a higher percentage of children who take Ritalin or similar drugs. The per capita distribution rate is most likely due to the small size of the state's population, which means that the few providers who prescribe a lot of Ritalin can significantly skew the average. The committee also found that, except for a few anecdotal accounts, there's no evidence that school personnel have pressured parents to place their children on Ritalin, a finding contested by the New England Citizens Commission on Human Rights, a Church of Scientology group. (Intellihealth/The Associated Press, 8/18/05)

Latest Research

Prison Violence Falls Due to Awareness and Lawsuits: Due to an increased sensitivity to separating violent offenders from offenders who are more peaceful and an increased aggressiveness by advocacy groups in filing lawsuits to improve prison conditions, violence in state prisons has fallen significantly, a new study indicates. The state prison homicide rate fell about 90 percent, from 54 per 100,000 inmates in 1980 to four per 100,000 in 2002 The . suicide rate fell more than 60 percent, from 129 per 100,000 in 1983 to 47 per 100,000 in 2002. Meanwhile, the death rate in prisons from AIDS-related causes fell from 100 per 100,000 in 1995 to 15 per 100,000 in 2000. The study was conducted by the federal Bureau of Justice Statistics. (USA Today, 8/22/05)

Chronic Nervousness and Anxiety Might Be Risk Factors for Suicide Attempts: People who describe themselves as chronically nervous or anxious are more likely to be hospitalized for suicide attempts within a 10-year period than people who report being more calm, a new Swedish study indicates. The correlation between reported feelings of nervousness and hospitalization for suicide attempts was particularly strong in men; nervous or anxious men are nine times more likely than other men to be hospitalized for suicide attempts compared with women with such feelings, who are three times as likely as other women to be hospitalized. The study was published in the Journal of Epidemiology and Community Health. (Reuters Health, 8/22/05)

PTSD and Depression Affect Female Soldiers at About the Same Rate as Male Soldiers: Female soldiers in support units in Iraq do not have a higher incidence of stress-related mental health problems in the months after returning to the United States than do their male counterparts, a military study has found. Men and women in similar support positions, such as truck driving, which have proved to be extremely dangerous in Iraq, have about the same rate of depression (6 percent for men and 8 percent for women) and PTSD (11 percent for men and 12 percent for women). (Intellihealth/USA Today, 8/18/05)

Pharmaceutical News

Paxil Users Need Close Monitoring, Researchers Contend: Norwegian researchers concluded in a study published in the journal BMC Medicine that adults who take the antidepressant drug Paxil should be closely monitored because the drug - and other similar antidepressants - may increase the risk of suicide attempts. The researchers based their conclusion on data from previously unpublished studies. Paxil´s manufacturer, GlaxoSmithKline, called the results "flawed and misleading" because the researchers used old data while ignoring more recent, comprehensive studies. (Reuters Health, 8/22/05)

NSW: Charges dismissed against man who threatened to kill Carr

AAP General News (Australia); 8/26/2005

NSW: Charges dismissed against man who threatened to kill Carr

A Liberal staffer who made death threats against former New South Wales premier BOB
CARR has had charges against him dismissed on the grounds of mental illness.

21-year-old JULIAN EVANS faced Waverley Local Court on charges of giving false information
to police and intimidating a police officer.

The offences relate to threats of an assassination plot he made to Mr CARR's office in April.

EVANS, who once worked as a researcher for Opposition Leader JOHN BROGDEN, allegedly
detailed his elaborate plot during a 50-minute telephone call to Inspector PETER BENIC,
head of the premier's security unit.

After his first court appearance in April, EVANS was charged with intimidating a police
officer after he was heard threatening to kill her.

But Magistrate LEE GILMOUR has ruled that the charges against EVANS be dismissed because
he suffers bipolar disorder.

Defence lawyer PAUL HOGAN had applied for the dismissal, saying his client had made
progress in private treatment since his arrest.

Ms GILMOUR says EVANS was affected by his mental illness at the time of the offences.

© 2005 AAP Information Services Pty Limited (AAP) or its Licensors.

THE JUMPER WHO LIVED: After beating the odds by surviving a 220-ft. plunge, Kevin Hines has a mission: preventing suicides at the Golden Gate Bridge.

People Weekly; 9/5/2005

Byline: Thomas Fields-Meyer; Andrea Orr in San Francisco

You must die." The voices in Kevin Hines's head kept repeating the words until, after years of depression, the 18-year-old San Francisco college sophomore could take no more. On Sept. 25, 2000--after a night drafting suicide notes--he took a bus to the Golden Gate Bridge. There he paced the pedestrian walkway crying hysterically. "I decided if someone asked what was the matter, I wouldn't do it," he recalls. Just one tourist approached--with a request to take her picture. (He obliged.) When she left, Hines set down his backpack full of notes and catapulted over the chest-high pedestrian railing into the air. "The second my body left the ledge," he says, "I realized, I don't want to die."

Miraculously, he didn't. Hurtling more than 200 feet toward the icy waters of San Francisco Bay, Hines "looked down and thought, I've got to get myself feetfirst." Seconds before hitting the water, he whispered a prayer, then threw back his head so that his body struck the surface at a 45-degree angle. Hines fought his way to the surface, where the Coast Guard shortly fished him out. As he recuperated from two shattered vertebrae, a ruptured stomach and liver and pneumonia at a local hospital, a priest paid a visit. "You are a miracle," he told Hines. "Now go out and save lives."

Now 23, Hines is trying to do just that. Still being treated for bipolar disorder, he has joined with mental health advocates and the families of suicide victims to speak to young people about depression and to campaign for a barrier on the bridge. Officials stopped publicizing figures in 1995, when the number hit 997, but concede the landmark attracts about one jumper every two weeks--making it one of the world's leading suicide locations. "When people with depression get to an impulsive end stage," says psychologist Dan Riedenberg, who heads a Minneapolis-based suicide prevention and education group, "the bridge is simply too accessible." Hines says even a small fence might have changed his mind, and Jenni Olsen, producer of a 2005 documentary about bridge suicides, agrees. "If it is a little more difficult, it would cause people to think," she says.

Hines has yet to convince the Golden Gate Bridge Highway and Transportation District. "Adding a barrier sounds easy," says spokeswoman Mary Currie. "But whenever you make changes to a suspension bridge you risk problems, like destabilizing its wind profile." Prodded by Hines and others, the agency voted in April to study the matter, but polls of San Franciscans show 50 percent of them oppose any barrier, which may cost up to $25 million to build and could mar their bridge's beauty. Agency officials point out that the bridge already has phones that connect to suicide hotlines and trained guards to recognize jumpers. "We probably save three or four people," says Currie, "for every one that jumps."

How he reached such despair still baffles his parents, Patrick, a banker, and Debbie, a nurse, who say Kevin was a popular student who thrived academically until 10th grade, when he began having mood swings. "All of a sudden," says Patrick, "he fell off the edge of his earth." Diagnosed as bipolar, he went on medication, but while attending City College of San Francisco suffered the depression that led him to the bridge that foggy morning. When he regained consciousness, "I was just glad to be alive," says Hines. "It woke me up from my depression."

After a lengthy recovery, Hines went back to college, where he's majoring in theater--and found his mission. Still, he says his own demons are far from banished. Twice since his leap he's been hospitalized, but now he vows to make the fight against his illness last a lifetime. "I was blessed--I was given a second chance," he says. "I'm very happy with where I am right now."

COPYRIGHT 2005 Time, Inc.

Musician's widow finds a purpose and a way to make ends meet after her husband's death.

The Orange County Register (Santa Ana, Calif.) (via Knight-Ridder/Tribune News Service); 8/29/2005

Byline: Ann Pepper

SANTA ANA, Calif. _ Flamboyant, multitalented Johnnie Carl, the musical director at the Crystal Cathedral in Garden Grove, Calif., took his own life eight months ago just as fame was tuning up to play his song.

Carl, 57, was battling bipolar disorder, which pushes one of five who suffer from it to suicide. He left his family a legacy of cherished memories and music but also one of grief and insecurity.

Carl's widow, second-grade teacher Linda Carl, says all that's happened since that dark Dec. 17 _ including the potential loss of her home _ has led her to understand her own unexpected future.

Linda stands outside her home and lets her eyes linger over the view from her sunny back yard that seems to stretch into the round, brown Yorba Linda hills. She points out a little waterfall above that blue Jacuzzi pool that she didn't quite get finished in time for her husband to use.

"I was building him a sanctuary here," says Linda, 53. "Someplace to come home to. Someplace quiet."

Home wasn't always a peaceful place for the Carls and their children: Brandon, 23, Evan, 20, and Alyson, 16. As Johnnie Carl moved into his 40s his bipolar disorder began to disrupt their lives.

At times, he reached glorious moments of creativity and turned out thousands of pieces of music that moved people spiritually and emotionally.

He won three commissions to provide music for papal visits to the United States. He earned gold and platinum records for his arrangements and orchestrations for stars such as Celine Dion and John Tesh, all the while handling Crystal Cathedral productions.

During these heady times, he'd treat his family to dinner, ordering everything the children wanted. He spent freely, even irresponsibly, on what sometimes seemed to be nothing at all, Linda said. He sent roses for no other reason than to make clear that his love was as strong as it had been more than 28 years ago when he saw her for the first time _ looking up at her after she stepped on his hand at a hayride.

Then with equal force, Carl dropped into darkness. His work became a chore. He turned despondent and violent. He tried suicide more than once and threatened it even more.

"We woke up one morning, and he'd left a message on the answering machine and he sounded awful," Linda said. "Hysterical. 'I can't stand it anymore,' he said. 'I can't stand to put you or myself through this anymore.' "

Carl told her he had shifted all their money to her checking account. He was done. A message young Alyson left on her father's cell phone pulled him back from the brink that time.

About four years ago, doctors found a three-drug cocktail that put Carl on secure footing. After that, friends say, his genius appeared harnessed to his will.

During his last year, he was preparing to arrange, conduct and produce concert pianist Roger Williams' next album. He'd completed three arrangements for a Daniel Rodriguez album he was conducting and producing. He had been asked to do a movie score. He was looking forward to building his Web site, traveling more and working with choirs and musicians across the country.

"He was just really excited, and so was I, about his future. There was absolutely nothing in his life that was distressing to him. Life was better than it had ever been before. I mean, I loved him so much, and he knew it," she says, dissolving in tears. "And he felt the same about me."

Some things about her husband she discovered only after he died. A cathedral custodian scrimping to put his son through medical school told her Carl paid his wife's medical bills. Another man said her husband helped pay for his mother's funeral.

"I saw it later in Johnnie's check register," she said, sobbing. "I knew he was supporting kids with instrument rentals and music lessons, but not about things like this.

"You ask me how Johnnie's music touched me, and I want to tell you, it wasn't his music. The music was secondary. That's why he was able to go on for so long, I think, because he knew that I didn't love his music so much as I loved him."

Roger Williams was also particularly close to Carl.

"What was most special about John was his whole personality _ the way he could get into music with you, the way he soaked up your ideas and could make them come to life.

"He could blend with almost any style. That was the great gift of genius ... to communicate with people on their level.

"And the great tragedy is that he was just coming into his own."

Three months before Johnnie Carl died, doctors took him off one of his stabilizing drugs, fearing kidney damage. By November he was so troubled he was admitted into UCI Medical Center for five days.

On that Thursday in December, Williams called to talk about plans to perform together. He didn't recognize Carl's voice.

"It was really scary," Williams says. "I don't think I've even heard a voice like that in a horror movie. He said, 'I'm going to kill myself.' I tried to argue with him, but he hung up. I think he started shooting five minutes later."

Linda kneels on the carpet in her living room, watching a video of her husband's memorial service. Williams is playing a tender rendition of "The Rose." The music trills and rolls like a waterfall. The two men had joked about playing at each other's funerals, and Carl had asked Williams to play the piece.

Other friends have stepped up, too. Linda says she can't express enough gratitude for the meals, flowers and affectionate care.

Five men who call themselves "The Carl Brotherhood" gave her a framed document promising to "comfort, protect and defend" their old friend's family. One of them, Steve Kallenbach, reinstituted Carl's tradition of treating the whole family to dinner from time to time.

"The kids just love it," Linda says.

She has deep worries that are carrying her to unexpected places.

The circumstances of Carl's death voided his insurance. Although he worked at the cathedral for more than 30 years, he had no pension, Linda said. The family is in debt. She supports the family on her teacher's salary with some earnest help from her children.

Brandon has moved home from UC Irvine and works as a server at an Italian restaurant. Evan has taken on two jobs, one at a deli near home and another Sunday mornings at the Crystal Cathedral. He's learning how to run his father's music Web site. Alyson turned 16 in June and triumphantly landed a job at a local supermarket.

This is all part of God's plan, Linda says.

"I'm going to get religious on you here," she says with a little smile. "I feel very fortunate to see God's plan here because I don't think most of the time we're allowed to.

Linda believes her financial situation is God's way of pushing her to ensure her husband's music is heard. Despite her grief and exhaustion, she needs to find a way to make it happen, if for no other reason than to help her family survive.

"I think that I am meant and the kids are meant to promote Johnnie's music. First, because we need to stabilize ourselves financially because none of us want to leave this place. This is our home. This is where we had our Johnnie.

"But also because I think Johnnie left us a legacy in his music and his love that he gave to me and the kids. And I feel like I have a huge obligation to do something good. He brought so many people to the church with his music.

"Many, many times I heard people say they were coming to the cathedral ... or tuning in to the cathedral 'because I want to listen to the music. It touches me.'

"And because I truly believe that if he had lived another year, if he had completed 2005, he would have been extremely well-known," she says, pulling a tissue from a box beside her. "He was right on the cusp."

Just about the time she was coming to these conclusions, almost as if it was part of a plan, Linda got a phone call from a former musical colleague of her husband's.

Jim Moseley, a respected trombonist and entrepreneur, owns the rights to a CD Carl and he recorded called "James Moseley with Roger Williams and Members of the London Symphony Orchestra."

Moseley had some success with the album, but forgot about it as his own career blossomed.

"I used to think Johnnie could do so much musically," Moseley says. "Once, when we were on a jet to London, he told me he was arranging one of my songs in his head."

By the time they landed, Carl had the song ready for 80 musicians.

"It's what he heard in his mind. It's a huge talent."

At the same time, Moseley, said, "(Carl) thought I could make stuff happen."

So Moseley put in a call to Linda, offering to put the CD back on the market and give half of the proceeds to his old friend's family.

Linda says she's surprised and grateful for the offer. It's a perfect start to her plan to stabilize the family's finances and make sure her husband's music gets heard.

Soon, she hopes to create her own compilation. She's already got the name for the CD: "My Tribute: The Best of Johnnie Carl."

If the CDs succeed, Linda wants to use some of the proceeds to fight bipolar disorder.

"I think there is a purpose in this," she says. "I want everyday people to hear this album, this music, especially people who are suffering. I think that's most of us for one reason or another."

(c) 2005, The Orange County Register (Santa Ana, Calif.).

Visit the Register on the World Wide Web at

Distributed by Knight Ridder/Tribune Information Services.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail

COPYRIGHT 2005 The Orange County Register

Medicaid recipients cope with cutbacks

St. Louis Post-Dispatch; 8/28/2005; VIRGINIA YOUNG, AND CLAY BARBOUR; Of the Post-Dispatch

Gina Abrams sat in the dentist's chair for what she hoped would be the last time in her life.

The 48-year-old Affton resident had come to the dentist to have stitches removed from the bottom of her mouth, where her teeth used to be.
Abrams decided to have all of her bottom teeth pulled, rather than deal with life without dental insurance. She is among thousands of St. Louis-area residents coping with the latest wave of Medicaid cuts.

Beginning Thursday, the state will no longer pay for medical services such as physical therapy, hearing aids, feeding tubes and dental care for most low-income adults on Medicaid.

Also taking effect are strict income caps for the elderly and disabled. About 33,912 people -- including 6,173 in the St. Louis region -- will either lose coverage entirely or begin paying part of the cost.

Gov. Matt Blunt, a Republican, proposed the retrenchment. He said taxpayers can't afford the program, which covers about 1 million Missourians. The changes, combined with earlier cuts, will save more than $145.6 million in state money. Missouri also will forgo about $235 million in federal funds.

The result will reduce Missouri's Medicaid benefits, in many areas, to the minimum levels allowed by federal law.

Unintended impact

The impact is far-reaching and, in some cases, life-threatening.

Linda M. Dallas runs four homes in Jefferson County that take care of people with profound to severe physical or mental disabilities. Seventeen of the 47 residents use feeding tubes. Otherwise, they would.phpirate food into their lungs.

Such "enteral nutrition" -- feeding tubes that go directly into a person's stomach -- is on the list of durable medical equipment that won't be covered. So Dallas, executive director of Pony Bird Inc. in Mapaville, has been studying the options.

She filed paperwork to continue feeding tubes for residents who are blind, because legislators exempted the blind from cuts.

Dallas was confident that the Department of Mental Health would pick up the tab for anyone that Medicaid wouldn't cover. But in an odd twist, that means state taxpayers will pay the full bill instead of recouping 60 percent from the federal government under the Medicaid program.

In another unintended impact, as many as 2,000 mentally retarded people who work in sheltered workshops must choose whether to give up their jobs or pay hundreds of dollars a month to stay on Medicaid.

Most have Social Security disability checks that exceed the new income limit -- $678 a month. In general, people who want to stay on Medicaid must use any income over the cap to pay medical bills.

Families are agonizing over the decision. The workshops often are the center of workers' lives, a supportive place where they can socialize with peers and be productive.

Joe Loepker, 34, of O'Fallon, Mo., will owe $175 a month, or more than half his take-home pay. He boxes consumer products at Boone Center Inc. in St. Peters.

Loepker, who has Down syndrome, has worked since he was 21 and rarely misses a day, said his mother, Frances Loepker. "He loves the workshop," she said. "He's very happy."

While Joe Loepker has health insurance through the federal Medicare system, he needs Medicaid because it provides the bus that takes him to work, relieving his 80-year-old father of that burden.

Doing without

For many people, the cutbacks mean they will do without. Abrams, who visited the dentist last week, has wrestled for years with bipolar disorder and drug addiction. Clean for the past three years, she is on full disability through Social Security; she receives $857 a month.

Without Medicaid coverage, the thought of trying to pay for dental services out-of-pocket scares her. She was in the process of getting dentures for her top teeth when she decided to go all the way.

"I was going to need a lot of work on my bottom teeth," she said. "It was not a matter of 'if,' it was 'when.' So when I got that letter telling me Medicaid wasn't covering dental anymore, I made the only choice I could."

Abrams' choice may seem extreme, but others understand her sense of desperation.

Cynthia Applegate, 47, of St. Louis, fell in her apartment several months ago and tore tendons in her wrist. Last week, she started what was supposed to be a 12-week stint of rehab. On Thursday she attended her fourth and last visit to the physical therapist.

"Now what do I do?" she said. "I can't grip anything. Who can afford to pay for physical therapy without insurance?"

Like Abrams, Applegate suffers from severe bipolar disorder and is on disability. She lives on about $750 a month in disability payments.

"The only thing I can do is hope my therapist can give me some exercises I can do at home," she said. "It's either do that or do nothing at all."

Such sentiments are growing more common these days, according to Gary Morse, executive director of Community Alternatives.

The nonprofit organization helps the homeless and mentally ill get back on their feet. This often means addressing severe medical issues. For people such as Morse, the changes in Medicaid are especially bothersome.

"Another strand in the safety net has been cut," he said. "Now more people will fall through. There will be more illnesses, a higher mortality rate and in the end more people in our emergency rooms, which will drive up the cost for everyone."

"Optional" equipment

Even some Republican legislators are troubled by the cuts, especially those involving durable medical equipment. That term covers everything from canes, walkers and hospital beds to catheters, wheelchair batteries and pressure-relieving cushions. Those items will no longer be covered for adults living in their homes, unless they're pregnant or blind.

"In federal Medicaid language, they use the word 'optional'" for the equipment, said Rep. Wayne Cooper, R-Camdenton. "I don't see some of these things as optional."

For example, the state will provide diabetic supplies but not diabetes self-management training. Cooper, a physician, said supplies won't do much good if diabetics don't know how to monitor their blood sugar, inject medication and eat properly.

Mike Ditmore, Blunt's Medicaid chief, said he expects many patients to file appeals to get optional services. The state can grant exceptions if the lack of equipment could lead to death or the need for a higher level of care.

Medical equipment "certainly is one of those areas we'll take another look at, and we'll have the history of how many of these wound up with exceptions," Ditmore said.

Disabled people say that without medical equipment, they could be forced to move to nursing homes, which will cost taxpayers more. Medicaid will still furnish equipment for nursing home patients.

Also spared was children's coverage. In fact, Missouri will continue to provide one of the broadest programs nationally for children. Families earning up to three times the poverty level can participate.

But starting next month, most parents will have to chip in. For example, a family of four that makes up to $35,808 annually will owe $24 a month; a family of four that makes $43,548 will owe $90.

If parents don't pay the premium by Sept. 30, their children's Medicaid cards will be canceled immediately. The quick timetable worries some.

"For families who are already living in crisis and living in constant chaos, it's a lot to expect," said Jessica Woolbright, who works with battered women and their children at two St. Louis-area shelters.

This week's reductions follow the elimination in July of coverage for 26,308 people -- mainly single parents. By next July, the state will have forced an estimated 90,604 people off the rolls.

For those still covered, it's not over.

A legislative commission will recommend an overhaul of the Medicaid system by Jan. 1. And on that same day, elderly and disabled people who qualify for both Medicaid and Medicare must switch from state-run prescription drug coverage to a new federal plan.

Abrams and Applegate take medicines that help regulate their psychological conditions. Now, Medicaid and Medicare cover the costs of the drugs, which run about $1,500 a month for each woman. Without Medicaid, Abrams and Applegate would each face monthly prescription tabs of about $300 apiece.

Said Applegate: "If I don't have my meds, I will end up in an institution, in jail or on the streets."

Medicaid cuts taking effect Thursday

Gov. Matt Blunt and the Legislature:

- Tightened eligibility for the elderly and disabled. For full coverage, monthly income can't exceed $678 for single people and $909 for couples.

- Eliminated a program that covered disabled people with income up to $1,940 a month if they worked at least part-time.

- Axed many services for adults, unless they are pregnant, blind or in nursing homes. Examples include dental care, physical therapy, hearing aids, eyeglasses, podiatry and equipment such as patient lifts, hospital beds, catheters, and crutches. Patients can seek exceptions.

- Required more families in the Children's Health Insurance Program to pay premiums ranging from 1 percent to 5 percent of their income.

(Copyright (c) 2005 The Post-Dispatch)

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