THE FACES OF MEDICAID
One is a little girl whose eyes twinkle when it’s time for music class at school.
One is a mom whose Alzheimer’s disease grew so severe she forgot how to use a spoon.
One is a man whose greatest joy at his job is placing foam covers onto coat hangers.
In Colorado, one of every five people receives health benefits through Medicaid. And their lives may be about to change dramatically.
The revisions to Medicaid proposed in the Republican-backed health care plans currently in Congress would constitute the biggest restructuring of the program in generations, health experts agree. The plans would cut the growth of Medicaid spending by hundreds of billions of dol- lars nationwide and, for the first time, place strict dollar limits on how much the federal government contributes to Medicaid programs in each state.
For Colorado, these changes would mean $14 billion to $15 billion less in federal revenue for the program over the plans’ first 10 years compared with current law, according to the nonpartisan Colorado Health Institute. State officials have said it is all but certain, if those cuts take place, that they would have to rethink who should be eligible for Medicaid and how much help those individuals should receive.
That means programs that provide health coverage to the poor and the low-income, the disabled and the majority of people in nursing homes would come up for review.
Programs that help people with disabilities live independently or that provide in-home care to children would face scrutiny.
Some Medicaid beneficiaries say they worry the changes would pit groups of needy Coloradans against one another, all fighting over diminished resources.
“Bottom line?” said Marc Williams, a spokesman for the state’s Department of Health Care Policy and Financing, which administers Medicaid in Colorado. “Anything and everything is at risk in the event of a federal cutback that has been suggested.”
For Linda Gorman, a health policy analyst at the conservative and libertarian-leaning Independence Institute, the changes wouldn’t be all bad. Medicaid, she argued, has seen spending rise dramatically in Colorado in part because the state brought so many people under its cover — its caseload has tripled in the past decade. The program should first and foremost care for the disabled, she said. Trying to turn it into a universal insurance program for large swaths of the state, she said, endangers that mission.
“We need to do some serious thinking about what Medicaid is for,” she said. “It shouldn’t be to provide insurance for healthy people. There’s no point in spending public money on healthy people.”
But for Moe Keller, a former state Democratic lawmaker who is a vice president at Mental Health Colorado, the spending cuts are almost unthinkable. Medicaid provides addiction treatment and mental health care and preventative care that catches little problems before they become bigger ones, she said. It helps pay for the births of nearly half of all children born each year in Colorado and provides a vital safety net for everyone else, she said.
“There is a shocking ignorance on the part of elected officials and the public about who these people are,” she said of Medicaid’s enrollees. “They think they’re just sitting around eating bonbons. And they’re not. They’re working individuals.”
Here are the stories of three such people, three of the faces of Medicaid in Colorado.
Carol Meredith refers to the years before her son gained Medicaid coverage as “the bad old days.”
Those were the years when Alex would hit himself or others, escape from the house and wander away, and have run-ins with police officers who had to act as both law enforcers and behavioral health counselors. Alex was diagnosed at 3 years old with autism, and, without Medicaid coverage, it was up to his parents to pay for help.
“We would max out on credit cards trying to pay for his services,” Meredith said.
It wasn’t until he gained coverage under a so-called Medicaid “waiver” program with the state that he began receiving the kind of care that Meredith always hoped he would. Colorado offers more waivers than any other state in the country, allowing kids and adults to qualify for special services covered by Medicaid that they might not otherwise be able to receive. Nearly 45,000 people are covered under waivers in Colorado currently.
But such waivers are optional for the states to provide, and Meredith says she worries they could be the first to go under cutbacks.
Through individualized care provided by the waivers, Alex — who is now 33 — lives apart from his parents in a condo. He has a job at a local thrift store, where his favorite task is placing foam covers on the coat hangers. He’s stopped hurting himself so much.
And Meredith said it could all disappear if Alex’s waiver programs do.
“It’s very, very scary,” said Meredith, who is the executive director of The Arc of Arapahoe and Douglas counties. “You kind of Medicaid covers more than 1.3 million people in Colorado — roughly one of every five people in the state. The Republican-backed proposals in Congress would have a significant impact on that population. Individuals with disabilities thought you had it figured out, after incredible wait lists and trying to get the system to work and finally, finally, finally … but if they say ‘All gone,’ I don’t know what happens with him. I don’t know what happens with three-fourths of the people I work with at The Arc. It’s not just us. It’s everybody. It’s really, really scary.”
Alzheimer’s attacked early for Danielle Haraburda’s mother, Linda. She began showing signs of the disease in her 40s. By age 52, she was gravely disabled.
A nursing home was her only option, but soon she ran through all the money in her savings. Haraburda moved her mother into a nice facility in Arvada while working through a six-month process of signing her up for Medicaid. In the meantime, Haraburda paid the nursing home bill out of her own savings. It was $7,000 a month.
“It would have bankrupted me,” said Haraburda, an attorney. “It would have wiped out every bit of savings I had. I would not have a house.”
Slightly more than 60 percent of people living in Colorado nursing homes receive at least some support from Medicaid, according to the Kaiser Family Foundation.
no data 29 to 35% 36to40% 41 to 45% 46to50% 51 to 56%
State average: 42% And, while people with disabilities and adults over 65 make up about 12 percent of the state’s Medicaid population, they account for 42 percent of the Medicaid spending.
It’s a dynamic that causes Haraburda to fear that a cashstrapped state Medicaid program might try to skimp on nursing home care.
“I’m worried about how much money they’re going to lose,” she said. “I’m worried about whether my mother’s facility is going to turn into one of those places that smells like urine and the nurses are underpaid and all working two jobs.”
It was time for yet another doctor’s visit during yet another allmorning visit to Children’s Hospital Colorado, and Cecilia Fischer rolled her eyes as any 9-yearold would.
When she was 11 months old, Cecilia — Cici, to her family — choked on a little slice of peach and suffered a traumatic loss of oxygen. In addition to brain damage, the accident severely impacted her physical development. She does not speak, and she uses a wheelchair. The doctors’ appointments last month were evaluations in preparation for a spinal surgery to correct dramatic scoliosis — a result of underdeveloped muscles.
That surgery, though, won’t be on the government’s dime.
Cecilia’s parents, Jennifer and Matthew Fischer, work full time and have health insurance through their jobs. That insurance covers major medical issues and, though Jennifer says the family hits its annual out-of-pocket maximum in January each year, picks up substantial costs for Cecilia’s care.
But there is also much it doesn’t provide.
There’s the wheelchair — $25,000. And the formula — $500 a month — that Cecilia receives through her feeding tube.
There’s the computer that is helping Cecilia communicate, giving her parents a better sense of their little girl’s personality. And there’s the nurse who goes to school with Cecilia, allowing her to spend part of her day in a regular classroom and make friends.
All of that is covered through a Medicaid waiver, making Cecilia among the 45 percent of the state’s Medicaid recipients who are 20 or younger. In eight counties, half or more of the people receiving Medicaid are children or young adults.
“If these large cuts come in, over time, something has to give,” Jennifer said.
She wonders what that would mean for Cecilia but also for the rest of the family, including Cecilia’s three siblings.
Already the family scrimps on expenses and forgoes vacations to have enough money to pay for their health care.
“I don’t know what else we would have to sacrifice to make up the gap in care if we didn’t have Medicaid,” Jennifer said. “It’s … it’s … I don’t know. I don’t even want to think about it.”
She looked at her daughter. “Every kid like this has Medicaid.
“Medicaid isn’t what people think it is. It’s much more than that.”
Jennifer Fischer adjusts her daughter Cecilia’s position in her wheelchair between appointments at Children’s Hospital Colorado in Aurora last month. Cecilia, 9, suffered a brain injury when she was 11 months old. She requires around-theclock attention from her family, which relies on Medicaid as a secondary insurer.