House Appropriation Chairs have been in round the clock meetings deciding how to allocate sparse resources to cover essential state services.  With the budget deficit reaching $4.6 Billion, no line item is likely to make it through unscathed.  The House Appropriations subcommittee on Health and Human Services (HHS) discussed cuts in optional services that would slice to the very core of Medicaid as we know it.  Proposed cuts for discussion include the elimination of eye and dental services for adults, reductions in prescription drug coverage, limits on dispensing fees for pharmacists, massive reductions in personal care services, mandated prior authorizations and electronic claims filings and the perennial cuts to provider rates.  Physicians could face cuts from .5% to 5% or even more.  The House HHS Appropriation Chairs have been directed to find $700 million dollars in cuts on top of what the Senate has already proposed.   The NCMS is working diligently with representatives across organized medicine to give House members a clear understanding of the local impact of any proposed cuts and adjustments.  As legislators discuss optional benefits in Medicaid, it is clear that many consider very few of these programs and services to be optional.