Tighter Med­i­caid bud­gets could threaten home care

Ser­vices save money and im­prove qual­ity of life for re­cip­i­ents

USA TODAY Weekend Extra - - TRENDING - Su­san Jaffe Es­ther Ellis holds an emer­gency call but­ton, pro­vided by Part­ners in Care, that she wears as a pen­dant around her neck.

Ten years ago, a driver ran a stop sign as Jim McIl­roy rode into an in­ter­sec­tion on his mo­tor­cy­cle. Se­ri­ous in­juries left him par­a­lyzed from the chest down. Af­ter spend­ing some time in a nurs­ing home, he re­turned to his home near Bethel, Maine.

McIl­roy does most of his own cook­ing since Maine’s Med­i­caid pro­gram paid for a stove­top that he can roll his wheelchair un­der­neath to reach the food-prep area. His new kitchen sink has the same fea­ture. Wheelchair­friendly wood floor­ing has re­placed McIl­roy’s wall-to-wall car­pet­ing.

The al­ter­ations plus a per­sonal care aide — all paid for by Med­i­caid — en­able McIl­roy to stay in his house, which he and his wife, who has since died, “worked re­ally hard to own,” he said. The ar­range­ment saves Med­i­caid roughly two-thirds what it would cost if he lived in a nurs­ing home.

McIl­roy de­pends on the fed­eral-state pro­gram’s grow­ing sup­port of home-based care ser­vices — along with 2 mil­lion el­derly or dis­abled Amer­i­cans who rely on them to live at home for as long as pos­si­ble. That cru­cial help could face se­vere cuts if con­gres­sional Repub­li­cans, though stymied this past week, suc­ceed in their push to sharply re­duce fed­eral Med­i­caid funds to states.

States can choose whether to of­fer Med­i­caid ser­vices at home, but nurs­ing home cover­age, which is more ex­pen­sive, is a re­quired ben­e­fit. Op­tional ben­e­fits such as home ser­vices would prob­a­bly be first to go if states face bud­get trou­bles, the Cen­ter on Bud­get and Pol­icy Pri­or­i­ties warned in an anal­y­sis in May.

Chil­dren with spe­cial health needs, older adults and peo­ple with dis­abil­i­ties greatly value home- and com­mu­nity-based as­sis­tance, said Sen. Su­san Collins, R-Maine, who chairs the Se­nate Se­lect Com­mit­tee on Ag­ing.

“That’s why I am deeply con­cerned with pro­pos­als that would sig­nif­i­cantly cut Med­i­caid, forc­ing gover­nors and state leg­is­la­tors to con­front dif­fi­cult bud­get choices, in­clud­ing how to main­tain th­ese crit­i­cal but op­tional ser­vices,” said Collins, one of three Repub­li­cans whose votes early Fri­day helped de­feat the Se­nate’s “skinny re­peal” mea­sure that would have scut­tled the Af­ford­able Care Act.

Though home ser­vices are not a re­quired part of Med­i­caid, they rep­re­sent a large share of Med­i­caid spend­ing. Med­i­caid ex­penses for long-term care con­sumed a third of the Med­i­caid bud­get na­tion­wide in 2015, and more than half of that amount went to op­tional home-based care, ac­cord­ing to a gov­ern­ment re­port. Nurs­ing homes got the rest.

“Stay­ing at home is so in­cred­i­bly im­por­tant,” said McIl­roy, 73, who grows cu­cum­bers, pep­pers and to­ma­toes on his deck.

De­mand for home-based ser­vices is out­pac­ing sup­ply. In Mary­land, more than 20,000 peo­ple were on a registry await­ing open­ings for Med­i­caid home­based ser­vices last month. About 160,000 older or dis­abled peo­ple across the coun­try waited for home ser­vices in 2015, ac­cord­ing to a Kaiser Fam­ily Foun­da­tion re­port last year. (Kaiser Health News is an ed­i­to­ri­ally in­de­pen­dent pro­gram of the foun­da­tion.)

Es­ther Ellis, 79, who lives out­side Los An­ge­les, re­ceived a new mat­tress this year from Part­ners in Care, a non-profit group that runs four of the 38 sites in Cal­i­for­nia’s Mul­tipur­pose Se­nior Ser­vice Pro­gram and pro­vides Med­i­caid-funded home ser­vices.

The mat­tress helps re­lieve her back prob­lems af­ter surgery. Part­ners also pro­vided a couch, a mi­crowave and an emer­gency call but­ton to sum­mon help.

“If it wasn’t for them, I don’t know what I would do,” Ellis said.

HEIDI DE MARCO, KAISER HEALTH NEWS

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