Protocol cuts services for some disabled adults
Advocates for the disabled told a panel of state House candidates last week the new method for allocating attendant care hours under a Medicaid waiver program has left disabled adults in the lurch.
Brenda Stinebuck, executive director of Spa Area Independent Living Services, said the new assessment protocol has reduced an Arkadelphia man’s hours to the point he may have to go to a nursing home. SAILS, a nonprofit referral and advocacy service for the disabled, hosted the candidate forum at its Hot Springs office.
Stinebuck said the resource utilization groups method, or RUGs, the state Department of Human Services began using in January 2016 has significantly reduced the help he receives for daily tasks such as getting out of bed, going to the bathroom, dressing, cooking and eating.
“He has been on the waiver since 1999,” Stinebuck said, explaining the man had given her permission to talk about his circumstance. “He was getting the full 56 hours a week, and he continued to have those hours until the algorithm system came out and his hours were cut exponentially. He’s very terrified that he’s going to have to go to a nursing home.
“He’s not the only one who’s fearful. We hear this from folks every day. They’re fearful for their lives. They’re so afraid on how to answer the questions correctly so they don’t get a reduction in hours.”
RUGs uses a computer algorithm to determine attendant care hours, replacing the previous assessment that relied on a DHS nurse to determine care hours for people with Alternatives for Adults with Physical Disabilities waivers. The waivers allow Medicaid funds to pay for services provided in the home rather than at a nursing home or long-term care facility.
DHS said the algorithm ensures hours are allocated equally for waiver participants with similar circumstances.
“DHS adopted the RUGs methodology in the ARChoices program for the purposes of objectivity and uniformity, so that individuals with the same diagnoses and needs in daily living were treated equally in terms of the attendant care hours they received following assessments,” Marci Manley, DHS deputy chief of communications, said in an email.
A Pulaski County circuit court permanently enjoined DHS in May from using the new assessment method, decreeing the promulgation of the rule enabling the change did not comply with the Administrative Procedure Act’s public notice and comment requirements. A DHS appeal of the injunction to the state Supreme Court is pending.
In the interim, DHS is not accepting waiver applications.
“They have literally put a stop to processing applications for people with disabilities,” Mary Jane Sherer of Superior Senior Care told the panel. “There’s nothing we can do. We can’t send caregivers into the home.”
Stinebuck said nursing home care is more expensive and less comprehensive than in-home services. The consulting firm that reported to the legislative task force on health care reform in 2015 said the state Medicaid program could save $200 million by 2021 if half of Medicaid expenses for long-term elderly and disabled care were used on in-home and community-based services.
The report said the national average is 50 percent, but in Arkansas only 35 percent of funding paid for in-home care.
“Everyone thinks nursing home care is 24 hours,” Stinebuck said. “The standard they’re judged on is three hours of face-to-face interactions a day. And it’s so much more expensive than in-home care.”
The panel said the nursing home lobby wields considerable influence at the state Capitol. According to financial disclosure reports filed with the secretary of state’s office, the Arkansas Health Care House Public Affairs Committee contributed more than $90,000 to candidates during the primary elections.
The committee, which advocates for long-term care providers, contributed the $2,700 maximum to Rep. Laurie Rushing, R-District 26, and Rep. Richard Womack, R-District 18. Rep. Les Warren, R-District 25, received $1,000, and Rep. Bruce Cozart, R-District 24, received $500.
All of the candidates hoping to represent Garland County in the House during the 2019-20 term were invited to last week’s forum, but only Kevin Rogers, Democratic nominee for District 22, Alan Hughes, Democratic nominee for District 26, J. Kent Perceful, independent candidate for District 24, and Warren attended.