The West Virginia Medicaid Recipients' Union would like to share with you some information about one Medicaid program – the MR/DD Home and Community-Based Waiver.

This program is intended to save government money by enabling beneficiaries to receive necessary Medicaid supports and services in their homes as opposed to more costly institutional environments.  This program now has approximately 3,500 participants statewide.  In an institutional setting, their care would cost an average of $6,400 monthly – for a total of over $268 million annually.  By taking advantage of this waiver, the price tag is far, far less.

Due to Medicaid's institutional bias, the MR/DD Home and Community Based Waiver program is considered "optional."  However, the Supreme Court's Olmstead decision makes it clear that people must have the option of living in their communities.  Medicaid waivers such as the MR/DD Home and Community-Based Waiver are one way of implementing Olmstead.

Unfortunately, a sizable chunk of the Medicaid dollars being expended on the MR/DD Home and Community-Based Waiver program is not benefitting its participants.  In many instances, the behavioral healthcare agencies are skimming up to 50% of the Medicaid reimbursement and passing on just HALF to the direct care staff actually providing the services.  Thus, the money is not being used for its intended purpose, and the participants are forced to deal with inconsistent, inadequate, and/or ineffective services, often involving the most intimate personal care.  (How would you like a different aide wiping your bottom each week?  Then, how would you feel when you learned that the behavioral healthcare agency was deliberately withholding half of the government money intended to pay your aide?)

Families are often forced to sacrifice one income so that a parent can remain at home to care for a family member who should be receiving Medicaid supports and services, thereby robbing our state of yet another taxpayer (which can't be good for the economy).

In spite of repeated pleas from "consumers" and advocacy groups, DHHR has done absolutely NOTHING to remedy this problem.  Then, to add insult to injury, DHHR continues to levy the full Medicaid reimbursement against the estates of the beneficiaries who have been bilked out of consistent, quality care!

DHHR claims that they've no control over what agencies pay their personnel.  Yet, DHHR writes both the Waiver regulations and the behavioral healthcare contracts.  DHHR also controls agency licensure.  Seems like there'd be room in there somewhere for a little control and accountability, doesn't it?

Then there's the multi-million dollar behavioral healthcare industry moaning about how tough things are for them.  They wail about the high costs of turnover for direct care staff.  Well, duh!  Jobs with poverty-level wages and no benefits have high turnover.  Fact of life.  Solution?  Fork over more of that Medicaid reimbursement so staff will WANT to stay.  It's called an INVESTMENT, and it has the delightful side effect of engendering quality services.

Let's take a closer look at just one of the services from the MR/DD Waiver menu: respite care.

Medicaid offers two levels of respite care.  Level I is provided by contracted staff and costs Medicaid $10 per hour.  Level II is provided by agency employees and costs Medicaid $12.50 per hour.  Assuming each Waiver participant accesses the full amount of respite care allowable (144 hours per month), Level II respite care costs Medicaid over $15 million MORE annually than Level I respite care would have cost.  Yet DHHR, at the behest of the behavioral healthcare agencies, recently decreed that agencies no longer had to provide Level I respite care.  Apparently DHHR can afford to just dismiss a potential $15 million annual savings.

Why, you ask, would DHHR do such a thing?  Well, because with Level I respite care, the behavioral healthcare agencies could not get their paws on a sizable cut of the Medicaid reimbursement.  Regulations had them limited to a maximum cut of 8% of the Level I respite care reimbursement (3% for administrative costs and 5% for the Medicaid Provider Tax).  Whereas with Level II respite care, the agencies could siphon off up to 50% of the Medicaid reimbursement.  To the agencies, that meant a cut of up to $37.8 million annually by providing Level II respite care as opposed to a mere $4.8 million by providing Level I respite care.

Is it any wonder a tax liability "crisis" was manufactured to promote this change?  Sure, there were (and are) valid concerns about independent contracting.  However, those concerns are not insurmountable IF motivated to find a solution.  Neither DHHR nor the behavioral healthcare agencies are so motivated – even when there's $15 million to be potentially saved each year.

One by one, agencies announced that they'll no longer be providing Level I respite care, although a few are maintaining the service, for now.  (Funny how that tax liability "crisis" isn't bothering those agencies.)  Contracted providers have the option of becoming agency employees (and taking a $2.95 per hour cut in pay).  Participants now have huge staffing vacancies that are filled only temporarily by those high-turnover employees – each one an invasion of privacy & an assault on dignity.

So, the next time you hear DHHR whine about money, give ‘em a chunk of this stinky cheese.