Obama’s Medicaid Cuts Add Cost in Kansas
As the recession continues to cut into state budgets, many states, my home state of Kansas — which is looking at a $510 million budget shortfall next year — included, are looking for ways to trim the fat.
Unfortunately, the method many are choosing is to cut “optional” programs like the Medicaid waiver.
In January of this year Kansas Governor Mark Parkinson slashed funding for the Medicaid program by 10 percent across the board.
The problem is, Parkinson isn’t thinking very clearly in the places he makes his cuts.
The cut to the Medicaid funding would save the state $22 million — so far, so good, right?
Wrong.
Federal law mandates funding for people who qualify for Medicaid and need to go into a nursing home or other institution. You cannot cut that funding.
What the waiver does is allow Medicaid funding to be used to cover non-hospital expenses, such as in-home care for people with physical disabilities. That program, by federal law, is optional: states are not required to fund those services, and so of course they were on the chopping block. The dirty little secret here is that by cutting that funding, they left $55 million in federal funding on the table.
The even dirtier little secret is it costs about $3,800 per month to keep someone in a nursing home, on average. It costs around $1,800 per month on average to keep someone at home.
Worse, the requirements for the waiver are identical to those for putting someone in a nursing home — so it’s not even good math to cut this funding.
Just getting half the 1,800 or so people who were admitted to nursing homes just since December 2009 back into their homes would save the state a little over $20 million a year. Which is a big chunk of the $22 million they cut. This leaves aside the fact that keeping people in their homes and communities is not only cheaper, but is better for the people on the waiver and for their communities.
These people are often able to stay in their jobs or otherwise contribute to the community, the organizations who help the disabled employ people to help care for them, and the state saves money on their care — everyone wins.
Obamacare’s “cost savings” come from being able to cut the healthcare budget and call it that. That’s it. Good luck with anything else.
I spent five years caring for my Mother at home after she had two strokes, one that took 95% of her eyesight and the 2nd that took away her judgment and the ability to recognize danger. I left a good paying job to do this, exhausted all our savings, hers and mine, to support us. Everyone tried to force me to put her in a nursing home, but we tried that for two weeks and, although there was nothing wrong with her brilliant mind, they consigned her to the Altzheimer’s wing, kept her tied in bed or in a wheelchair, put her in diapers and wouldn’t allow her to feed herself. She begged me to get her out of there before they killed her.
Had she stayed, Medicare/Insurance would have picked up the full tab, but instead, there was no financial aid available to me for doing the same job, only better, and with a lot more love. Not only that, but I end up being penalized since I lost all those working quarters toward my own social security benefits, not to mention that it is near impossible to break back into the working world when you are in you are in your late fifties and have a five year gap. And I now have no savings left to take care of myself in my senior years.
We live in California. There is something very wrong with a system that penalizes you for saving the government money. I couldn’t even claim my Mother as a dependent since she had some income from her own social security.
What this article does not discuss is that “optional” services probably cannot be legally eliminated, once offered by a state. States moving to eliminate such optional services are sued and the courts rule that the optional services may not legally be eliminated based on the “integration mandate” in the Americans with Disabilities Act. This requires state services to be provided in the “most integrated setting” available. If eliminating optional home and community-based services in the community means that Medicaid clients will need to move to a nursing home in order to receive services the integration mandate is violated, because nursing homes are considered institutions. Most likely the court will block the cut, regardless of the costs to the state. Many states seeking to reduce their Medicaid costs by eliminating optional services in the community have been blocked by the courts under this theory – most notably and recently in California and Washington States.
Actually Cathy, the courts haven’t blocked the cuts. States are reimbursed for nursing home stays by the federal government, but the law does not require the government to reimburse for “waiver” services. What the waiver does, is allow medicaid dollars to be spent on “non medical” care. In the past, the government has reimbursed all medicaid costs. Moreover, the states are not cutting the waiver entirely, but cutting the wavier budget. I could perhaps have made that more clear.
What happened, in Kansas at any rate, is that the Governor cut medicaid funding by 10% across the board. As federal law says nursing home stays _must_ be paid for, what the state cut was the amount of total waiver dollars available. It is not that the waiver is no longer in force, it is, but fewer people can now _get_ the waiver and the waiting list is longer.
As the requirements for the waiver are the same as for a nursing home stay, simply increasing the number of waivers approved would actually save the state money.
In many states, including mine (Washington State), home healthcare workers on the state payroll are required to join the SEIU. Wouldn’t it be a hoot to have the rank and file SEIU home health service providers joining with tea partiers to lobby the states together on this issue? It would totally turn the MSM on it’s ear!