THE FACES OF MED­I­CAID

The Denver Post - - FRONT PAGE - By John In­gold

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.

The son

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.”

The mother

Pre­na­tal

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.

Pre­na­tal

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.”

The daugh­ter

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.”

Andy Cross, The Den­ver Post

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.

Andy Cross, The Den­ver Post

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