Budget cuts squeeze health care programs for the elderly.
This piece originally appeared in The Vermont Standard.
The anticipated impacts of Governor Shumlin’s recommended cuts in a program that provides long term care primarily for low income, aged Vermonters have likely been softened. In his state fiscal year 2012 budget, Shumlin had proposed scaling back some services in the $175 million Choices for Care program to save $5.4 million in state and federal funds. The Senate and House versions of the budget restore much of that cut, but the remaining $2.6 million reduction could still create difficulties for some 1,800 elders state-wide who receive home and community based services as part of the program. In Windsor County, about 120 participants could feel the effect of the cutbacks.
Choices for Care is a component of Vermont’s Medicaid program, the Federally mandated but state administered health insurance initiative for low income individuals and families. Vermont established Choices for Care in 2005 with the objective of granting participants greater control over their long term care. The program operates under a Federal waiver that allows the state to offer residents who are Medicaid-eligible for nursing homes the option to instead receive care at home, or in enhanced residential care settings, such as assisted living facilities. Care delivered at home is typically substantially less expensive than nursing home care.
For those who chose home based or enhanced residential care, the program includes assistance with basic functions, called “activities of daily living” (ADLs), such as dressing, bathing, eating, and toileting. Participants can also get help, up to 4.5 hours a week, with important but more ancillary tasks deemed “instrumental activities of daily living” (IADLs), such as managing finances, arranging transportation, preparing snacks, and doing light housework. There is also an option for up to 720 hours per year of respite care, to give breaks to persons who normally provide unpaid care.
The Governor’s proposed budget halved both the paid assistance permitted for IADLs and the maximum hours of respite care. The House and Senate “restored” budgets bumped paid IADL hours back up to 3.5 per week, and raised the respite care cap back to about 540 hours.
Dr. Susan Wehry, the newly appointed Commissioner of the Department of Disabilities, Aging, and Independent Living, which manages most of the Choices for Care programs, acknowledges that the reductions in services may cause some pain.
“Part of the decision was an effort to protect basic activities of daily living, so there would be no cut there,” she says.
Other community programs hopefully can pick up some of the slack on IADLs; “the loss of an hour or two hours from one program wouldn’t necessarily mean that the case manager couldn’t help find some other way to get a specific need met,” she adds.
Wehry also said that the Department looked at trends in requests for respite care, and found that most participants don’t use the currently allowed 720 hours, and in fact about two thirds of participants don’t exceed 360 a year. She says the Department will consider need-based exceptions to a lowered cap on a case-by-case basis.
Savings in Choices for Care in the current fiscal year may ultimately provide additional funds for next year’s programs. Although a $1.5 million anticipated under-run of the 2011 budget was already figured into 2012 projections, any funds freed up from a larger under run will be used to avoid service cuts. “If fewer people go to nursing homes than we predict,” says Wehry, a trend that is reasonably likely, “that would leave us at the end of the year having spent less…than was appropriated. That money goes forward into the next year.”
The Choices for Care program is jointly funded. For every four dollars Vermont pays out, the Federal government chips in about six, up to a pre-set, five-year limit. The arrangement, however, multiplies the impact of state budget reductions because when the state cuts back its spending, the matching Federal dollars are lost as well. For fiscal years 2009 through 2011, Vermont’s share of the funding for Choices For Care was heavily subsidized by the American Recovery and Reinvestment Act. Loss of those funds meant the state had to make up a nearly $19 million hit to the 2012 Choices for Care budget.
The Vermont House and Senate are expected to reconcile their versions of the state’s budget this week.