Ohio cuts Medicaid costs with home aides
After 10 months in a nursing home recovering from hip surgery and cancer treatments, Teri Eldridge knew she needed to get back home or she’d waste away.
The oncologist treating her multiple myeloma recommended a bone-marrow transplant but told her, “You have to go home and get
stronger. You can’t do it here; too many germs. You need to control your environment.”
Eldridge, a 58-year-old divorced mother of two and former home-health aide, agreed.
At the nursing home, she stayed in bed most days, reluctant to leave her room because her weakened immune system left her more susceptible to illness.
“I didn’t know what I was going to do or who was going to help care for me, but I knew I had to go home,” Eldridge said. “I knew I could get better sitting on my swing or out back, I could go places and do a lot more at home.”
Ohio’s Home Choice program made that possible. It arranged for Eldridge’s move back to her Columbus apartment and daily visits from a health aide to help Eldridge bathe, dress and clean her house, as well as weekly visits from a nurse and physical therapist — all paid by Medicaid.
Established in 2008, Home Choice has hit a new threshold: It has transitioned 10,000 elderly, disabled or mentally ill Ohioans who qualify for Medicaid from an institutional setting into a home. Originally, the goal was to help 2,000.
The arrangement makes Eldridge happy and saves the tax-funded health-care program more than half of what it would cost if she were still in a nursing home. Better yet, her health has improved and she’s scheduled to get her bone-marrow transplant in early September.
“The program provides greater choice and control for people over the services they receive — and in the setting they prefer,” said Ohio Medicaid Director Barbara Sears.
Ohio, state officials say,
is second only to Texas in moving individuals from institutions to home and community-based settings. The youngest person transitioned was 2 months, the oldest was 101.
An analysis by the Department of Medicaid of 1,283 Home Choice participants in 2016 showed the average annual cost of their care was $32,533. That compares with $71,640 for their institutional-care costs before moving home.
With Ohio’s aging population and an increasing demand for long-term-care services, greater utilization of home and communitybased services has stretched Medicaid dollars.
Ohio now serves 60 percent of those receiving Medicaid long-term care through home and community services and 40 percent in institutional care. A decade ago, it was the opposite.
Nationwide, Ohio is among 22 states that spend more than half of their long-termcare budgets on home and community care, according
to the Kaiser Family Foundation. The financial benefit is clear.
But congressional Republican efforts to cut federal funding for Medicaid to states, some fear, could force the state to scale back the program.
Home and communitybased services are optional under federal Medicaid guidelines, but nursing-home care is a required benefit. If funds are limited, states would cut optional services first.
Eldridge doesn’t see much sense in those rules.
At home, she takes short walks, does puzzles, colors and watches old John Wayne westerns to keep busy and build her strength. Her son and daughter visit frequently, help with errands and accompany her to doctors’ appointments.
“I’ve gotten stronger and move around better,” she said. “Without (Home Choice), I wouldn’t be getting my bonemarrow transplant.”