Medicaid patients on the brink

Milford woman among patients in danger of losing Visiting Nurse Services

There’s not much that Carol Duffy can do for herself.

The 64-year-old Milford resident has several health problems, including multiple sclerosis, arthritis in the neck and a bulging disc. She uses a wheelchair and needs help with many basic tasks, including showering, preparing food and making the bed.

“I’m like a giant infant,” Duffy said.

But, for the past few years, she’s gotten help from Bridgeport based Visiting Nurse Services of Connecticut. She said someone comes to her house for roughly two hours every day to assist her with the many things she can’t do for herself. It’s a service that helps her live her life.

And she recently learned she could be on the cusp of losing it.

Duffy is one of nearly 1,900 VNS patients whose services are covered through Medicaid. In early August, the state Department of Social Services reduced payments to six medical home health agencies, including VNS, which serves clients in 57 communities, from Greenwich to Torrington.

The reduction was laid out in an executive order Gov. Dannel P. Malloy issued Aug. 11, in the absence of a state budget. The cuts are intended to save the state $1.9 million. However, those in the home health industry said the reduction could actually cost the state money, as it will require some agencies to stop

serving Medicaid patients, who will then have to resort to more expensive options, such as hospitals and nursing homes.

“We get that (money needs to be saved),” said Deborah Hoyt, president and CEO of the Connecticut Association for Health Care at Home, which represents 65 of the 90 medical home health agencies in the state. “We understand that the state budget is a mess. But we are the savings vehicle.”

Add-ons eliminated

The state’s cost adjustment to Medicaid payments eliminates “home health add-ons,” said DSS spokesman David Dearborn. These add-ons give extra compensation to home health providers — including VNS — who apply for them, and help cover such services as care for AIDS patients and safety escorts for caregivers who work in potentially unsafe neighborhoods.

VNS outgoing president and CEO William F. Sullivan Jr. said the additional funding has, among other things, helped his agency provide direct care to patients 24 hours a day, 365 days a year. Losing that money will be a major hit for VNS, which already loses $4.5 million a year serving its Medicaid patients, Sullivan said. He said eliminating the addons would increase that loss to $5.5 million for this year, requiring the agency to either dramatically scale back Medicaid services or eliminate them entirely.

“Moving forward, we have to ask ourselves ‘Can we continue to serve the Medicaid population as we do today?’ ” Sullivan said. “The answer is ‘no.’ ”

Sullivan said letters were going out to one group of Medicaid patients on Friday, stating that they had 30 days to find other care. The rest of VNS’ Medicaid population will likely a get a notice in October alerting them that they are about to lose services, unless something changes.

Changes needed

Hoyt, meanwhile, said eliminating the add-ons is a short-sighted move, particularly if it results in forcing people out of home health services and toward more costly alternatives.

She said the state saves more than $100 million a year on care for Medicaid patients who receive care at home instead of in a nursing home or other institutions.

“Home and communitybased care is the most effective form of care,” she said.

Not only do Hoyt and others argue that cutting the Medicaid payments has financial drawbacks, it has human costs as well. Duffy, for one, doesn’t know what she’s going to do if she loses access to VNS.

“I didn’t realize there were going to be such drastic cuts,” she said.

Hoyt said she hopes there is a way to avoid the deep reductions in funding and is willing to work with DSS to come to an alternative solution.

Dearborn said it seems unlikely at this time that the state will keep the addons, but he didn’t close the door on the issue.

“In a brighter fiscal environment, the administration and legislature would be in a better position to retain the addon,” he said in an email. “Even so, (the) administration is in the beginning stages of looking at alternative ways to modify payments for special complex services.”