Another Fight

All over the country there seems to be a lot of arguing going on around the care of people with developmental disabilities. It is refreshing to see people standing up and taking a strong position for what they believe in. I wish I saw more of this going on; paritcularly here in Oregon. From the Times Picayune in New Orleans...

Bills aim to cut cost of home-based care programs

Medicaid services help elderly, disabled
Saturday, May 31, 2008
By Jan Moller

BATON ROUGE -- After years of trying to reduce the state's reliance on institutional care for the elderly and disabled, lawmakers this year are complaining about the spiraling costs of the home- and community-based programs designed to replace it.

With three weeks left before the Legislature adjourns, several bills are moving through the process that aim to impose new cost controls and slow the growth of a waiver program that serves the developmentally disabled.

The bills, which are backed by the nursing home industry, come amid warnings from legislative leaders and the state Department of Health and Hospitals that home-care programs could eventually bankrupt the Medicaid program and reduce or cancel such services.

"The growth in these programs is something I don't believe . . . we'll be able to maintain," House Speaker Jim Tucker, R-Algiers, who sponsored one of the bills, told a Senate committee this week.

But advocates for the disabled question whether some of the changes are needed, and are fighting legislation that would scale back an ambitious effort, begun last year, to reduce the waiting list for community services that can stretch a decade or more.

At issue are two programs, financed by federal and state Medicaid dollars, that are designed to let elderly people and those with developmental disabilities to live independently.

The long-term personal care services program provides home-care attendants to help with cooking, cleaning and other activities for low-income people who are medically qualified for nursing home care. The New Opportunities Waiver, meanwhile, provides a range of services -- from home modifications to specialized nursing care and specialized medical equipment -- to people with developmental disabilities.

The health department says the personal-care program has grown from about $30 million in 2004 to a projected $192 million in the fiscal year that starts July 1. The cost for the NOW waivers, meanwhile, has escalated from $200 million in 2002-03 to $631 million next year, with the cost of care to many recipients topping $100,000 a year.

Charles Castille, undersecretary of the Department of Health and Hospitals, said the NOW waiver is sometimes referred to as a "gold card" because there are few restrictions on the types of services a person can receive once they've been accepted into the program.

Sandee Winchell, executive director of the Louisiana Developmental Disabilities Council, said the cost of home-care service, while expensive in Louisiana compared to other states, is still lower than the $176,000 annual per-patient cost to run a state developmental center.

"There's so much concentration right now and so much talk about the waiver being too expensive, but the institutional care right now is way too expensive," Winchell said.

House Bill 1273, by Tucker, would require the health department to develop cost control mechanisms for both programs by January, but does not say what forms the controls should take. The bill cleared the Senate Health and Welfare Committee this week and awaits a vote on the Senate floor before going to Gov. Bobby Jindal's desk for a signature or veto.

More controversial is House Bill 914 by Rep. Jim Fannin, D-Jonesboro, which would scale back a 2007 law requiring 12 percent of any budget surplus, up to $50 million, be used to pay for new NOW waivers, thereby reducing the waiting list that stands at 11,287. Thanks to the new law, the state plans to add 2,025 waivers next year, which then will have to be paid for in subsequent years out of the state general fund.

Fannin's bill, which awaits a vote on the House floor, would allow the surplus dollars to finance existing services, not just new waiver slots.

While disability advocates say Fannin's bill will hurt their efforts to reduce the backlog of people waiting for services, Castille said it would be irresponsible for the state to use surplus money for new services that might later prove unaffordable.