Tighter Medicaid budgets could threaten home care
Services save money and improve quality of life for recipients
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.