Chase Thomas still hopes state lawmakers find a way to reverse impending cuts to Medicaid.

But the Anniston nurse practitioner is prepared for them anyway.

“It'll impact me financially, but we’ll still keep the doors open, even if I have to borrow against my own house,” said Thomas, who owns Pediatrics Plus in Anniston. “But I honestly can’t imagine Alabama wants any more embarrassment, so I think they’ll do something.”

Tuesday Alabama lawmakers missed their last chance this legislative session to plug the $85 million hole in Medicaid spending when a bill to use one-time BP oil spill settlement money died in the Senate. And without any indication that Gov. Robert Bentley plans to call a special session to address the cuts, some hospitals and physicians are bracing for their impact.

“It’ll affect anybody that uses Medicaid … financially, it’ll be bad for everybody,” Thomas said of the cuts.

About 50 percent of Pediatric Plus’ patients use Medicaid, Thomas said.

Medicaid is a state-and-federal-funded healthcare program that serves about 1 million Alabamians below the poverty line, mainly children and the disabled.

The Alabama Legislature approved a budget last month that was short $85 million that Medicaid officials say will be needed to keep their program’s services operating at current levels. A bill that died in the Senate Tuesday would have used $70 million in oil spill settlement money to help shore up Medicaid.

The state expects to get more than $1 billion in damages from BP over the 2010 oil spill between now and 2033.

Among the cuts Medicaid officials are considering: eliminating adult prescription drug coverage to save around $50 million. Other services on the potential chopping block are coverage for outpatient dialysis and prosthetics. Payment cuts to primary care physicians are also a possibility.

Dr. William Curry, assistant dean for primary care and rural medicine at the University of Alabama at Birmingham, said the cuts would be particularly devastating to rural hospitals.

“Rural hospitals, which serve good-sized Medicaid and uninsured populations, depend on Medicaid to break even,” Curry said.

Curry said some rural hospitals would struggle to stay open after significant Medicaid cuts.

“Medicaid is not just about coverage of the poor,” Curry said. “It provides small systems the ability to provide services to everybody.”

Mike Alexander, director of Wedowee Hospital, a rural hospital in Randolph County, said Medicaid is already a poor revenue source.

“Medicaid doesn’t pay enough anyway, but we count on money from Medicaid to help keep the doors open,” Alexander said. “The margins are just so thin that a little impact at a small hospital is a big deal.”

Alexander said the problem is even if patients lose Medicaid coverage for medication or dialysis because of the cuts, his hospital must treat them anyway, meaning higher costs for the facility.

“How much money is in Medicaid has nothing to do with how many people come expecting service,” Alexander said.

In a Wednesday email to The Star, Rosemary Blackmon, vice president of the Alabama Hospital Association, wrote that the proposed cuts to physician reimbursements could significantly hurt hospitals.

“Probably the most concerning impact to hospitals will be the loss of physicians who cannot sustain the anticipated reimbursement cuts and will likely have to relocate,” Blackmon said. “Without physicians to admit patients, hospitals will be forced to limit services, cut staff, or in the worst case, close their doors.”

Brandi Parris, president of Anniston-based nonprofit Sarrell Dental Clinic, wrote in a Wednesday email to The Star that she was concerned about the impending cuts. With 18 clinics, Sarrell Dental is the main provider of dental care in Alabama for children on Medicaid.

“Unfortunately, these cuts would impact us just as they would all of the providers committed to serving Alabama’s low-income residents,” Parris wrote. “Because Sarrell is a low-cost, preventative leader in oral health care in Alabama, we believe that cutting reimbursement would undermine all of the achievements made to date by the continued commitment of dental providers to the patients they serve.”

Jim Carnes, policy director for Alabama Arise, a nonprofit that advocates for people in poverty, said his organization had seen little indication that Bentley was interested in calling a special session to address the Medicaid cuts.

“I think the message is clear; protecting the most vulnerable Alabamians isn’t a priority for this Legislature,” Carnes said. “It just doesn’t make any sense … we keep waiting for some leadership in the Legislature.”

Staff writer Patrick McCreless: 256-235-3561. On Twitter @PMcCreless_Star.