◊ JOB MATCH
 

March 21, 2005

Medicaid dilemma hits home
Jennifer Bundy, The Associated Press 

When Tucker Lewis was born 11 years ago, his brain was deprived of oxygen long enough to cause damage. He has cerebral palsy, cognitive delays, vision and physical impairments.

Tucker and his Morgantown family rely on the Medicaid Title XIX Waiver program to pay for night nurses, therapy, respite care, and residential habilitation, which allows his parents to be paid for the hours each day they train him on specific objectives like dressing, grooming and hygiene. Families can receive up to about $1,000 a month.

"It keeps Tucker at home with us,'' said his mother, Debi Lewis. "With his sleep disorder, somebody has to be up with him all night.''

The program waives Medicaid family income guidelines for middle-income families like Tucker's, and provides services to 3,844 adults and children who otherwise would have to live in a residential care facility for the mentally retarded. The idea is it is less expensive for the government to help families care for relatives at home.

West Virginia has to renew its federal application every five years and the latest application, due by March 31, proposes to make changes that would reduce costs and limit services. Medicaid officials don't know how much their proposals would save.

The overall Medicaid program faces a $156 million deficit because the number of participants and the cost of services is growing faster than the state's ability to pay, said Nancy Atkins, commissioner of the Bureau of Medical Services.

Medicaid serves over 300,000 West Virginians, paying more than 15 million claims a year.

Because West Virginia's economy is improving, the state's ability to receive $3 in federal money for every $1 in state money spent on Medicaid has dropped below a 73 percent match, leading to a $36 million in reduction in federal funding, Atkins said.

At the same time, West Virginia is phasing out the state tax on Medicaid providers, a dedicated source of the state match money.

State officials say they are trying to trim waiver program costs in ways that would have the least impact on clients, but families say the changes would put many clients at risk of institutionalization, defeating the purpose of the program.

Although Tucker would not be immediately hurt by the changes, the proposals would "adversely impact some families,'' said his mother.

For example, mileage reimbursements would be cut from 1,300 miles to 500 miles a month, and adult companions would no longer be allowed for people who live with their families, although families could still get respite care.

The reduction in mileage reimbursement for trips to medical and therapy appointments and community outings could make some clients prisoners in their own home, said Lewis, a leader in several consumer groups.

While most children are transported by their parents, the change would have a greater impact on adults who rely on others for transportation.

If care providers can't be reimbursed for mileage, they won't take clients out in the community, Lewis said.

When you decrease the quality of a disabled person's life, you increase their risk of illness and their medial expenses increase, Lewis added.

The elimination of companions for adult clients who live with their families, forcing them to rely solely on respite care, would be a hardship, Lewis said. Companions are basically personal aides for leisure time. Respite care workers are paid to take care of a disabled person or provide transport to give the family a break.

Adults can use companions for 644 hours a month, but only have 144 hours a month of respite care.

State officials say the changes haven't been finalized.

What the Manchin administration "wants to look at is some personal responsibility and how do we make sure we are serving the most appropriate folks, and that we are creating the parameters that don't allow people to abuse the system,'' Atkins said.

Medicaid officials have asked APS Health Care, a private contractor that helps manage other behavioral health services, to review West Virginia's waiver program.

"One of the concepts we are looking at is to take this waiver from a one-size-fits-all to a program that has levels of care in it,'' said Stephen Mullins, director of the state Office of Behavioral and Alternative Health Care within the Department of Health and Human Resources.

Lewis said levels of care would be a good idea.

"Any time anybody shows any move at all toward independence, they are at risk of losing waiver,'' Lewis said. "With a tiered system, they would just be bumped down toward a lower tier, which is much more conducive to independence.''
 

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This page last updated Friday 17 June 2005