Saturday 7 June 2003

The Title XIX MR/DD Waiver Program is an optional Medicaid program allowing eligible West Virginians to remain in their homes and communities rather than being institutionalized. This option not only benefits the recipients, affording them a better quality of life, but also saves the State a great deal of money – for institutionalization is very, very costly.

Currently, there are just over 3,000 recipients of MR/DD waiver services in West Virginia.

One of the services available via the MR/DD waiver program is called respite care. There are two types of respite care: Level I (contracted) and Level II (agency employed).

Level I respite care providers can be family members, and they do not have to have a high school diploma. This service costs the State $10.00 per hour. Of that, over $9.00 reaches the person actually providing the care as gross pay. The agencies are only permitted to keep a small percentage for expenses.

Level II respite care, on the other hand, requires providers to have a high school diploma as well as to meet an agency’s arbitrary criteria for employment. This service costs the State $12.50 per hour. The employing agency can skim as much as it chooses. Currently, the vast majority of the agencies providing this service keep 50% of the Medicaid payment – passing along only $6.25 per hour in gross pay to the employees actually providing the service. (This is poverty-level pay.)

The Bureau for Medical Services (BMS), which is a part of the Department of Health and Human Resources, recently decreed that behavioral health agencies serving MR/DD waiver clientele were no longer required to provide Level I respite care. It is now an optional service. Given Level II respite care’s built-in "profit" of roughly $6.25 per hour, which service do you think each agency will chose to make available to its clientele?

The MR/DD waiver program manual indicates that each recipient can receive up to 144 hours of respite care monthly if their interdisciplinary team recognizes the need. So, let’s do a little math:

Assume, for budgeting purposes, that each of the 3,000 recipients uses the full 144 hours of respite care each month. If Level I respite care is used, the cost to the State would be $51,840,000.00 annually. However, if Level II respite care is used, the cost to the State would be $64,800,000.00 annually. That’s $12,960,000.00 (almost $13 MILLION) per year in potential savings just by delivering Level I respite care instead of Level II respite care.

Through the recent program changes mentioned above, BMS just announced to West Virginia citizens that they don’t need or care about that money. Those are YOUR tax dollars it’s decided to hand to the behavioral healthcare agencies. Those dollars are not reaching the people actually doing the work. Instead, they’re paying the 6-figure salaries of the CEOs. Is that how you want your tax dollars to be spent?

This letter deals only with the financial considerations. There are also significant issues with regard to quality and consistency of care that must be addressed.