[Wheelchair In Trans-Allegheny Lunatic Asylum, Amy Simpson’s Flickr Photostream]
I ran across the Kaiser Health News piece below while I was researching a comment the other day. The policy “reform” that this piece addresses hits home for us since we have a number of close relatives who live in Tennessee.
I am concerned that this groundbreaking and pernicious policy will not be contained in this state alone. This policy is the result of a federal test pilot program conducted under the auspices of the Patient Protection and Affordable Care Act (PPACA). Apparently, this “new category of patient” has been approved by both the Tennessee State Legislature, and by the Obama Administration’s Department of Health and Human Services (HHS).
I find it to be nothing short of abhorrent that in order to expand Medicaid, we as a society are willing to allow some of our most elderly, sickly and frail citizens to possibly be forced to lie in their own excrement, and/or become malnourished (the ones who are unable to feed themselves) in order to “save a buck.”
The idea that folks who cannot perform two or more of the Activities of Daily Living [ADLs] can get by with no more than an occasional “visit” [or even a 4-hour, 5 day-a-week series of visits] from a home health care aide is absolutely ludicrous, in many cases.
The six (6) types of ADLs, are: Eating, Bathing, Dressing, Toileting, Transferring, and Maintaining Continence.
Now is the time to fight this new regulation and policy, before it spreads to other states.
Tennessee is still considered a nominally “purple state,” by some. My concern is that unless there is an organized and sustained pushback against this policy, many other states, especially the “red” ones, will jump to adopt this cost-saving policy.
Please help get the word out.
Here’s an excerpt from the Kaiser News piece entitled “Tennessee Cuts Medicaid Benefit Funding For Some Long-Term Care Patients.”
I acknowledge that this piece is a bit dated, but just as the “news” of America’s extreme poverty level did not seem to make it into the mainstream or liberal media, it appears that this story was ignored, as well.
In a unique experiment being watched nationally, Tennessee is revising its Medicaid long-term care options to make it harder for certain low-income elderly people to qualify for state-paid nursing home care.
The program, which has received federal approval and began this month, is the first of its kind in the nation because it creates this new category of patients who don’t qualify for nursing home care. Up to now, under federal law, everyone who receives long-term care under Medicaid first had to qualify to be admitted to a nursing home.
“Federal law requires that program eligibility be tied to eligibility for nursing homes,” said Matt Salo, executive director of the National Association of Medicaid Directors. “Tennessee is stepping ahead to create this new category of at-risk individuals whose benefits are not linked to nursing homes.”
But consumer advocates worry that the $15,000 annual limit will fall short of meeting the needs of some seniors, who could end up going without services or relying on funds from family or friends. Gordon Bonnyman, executive director of the Tennessee Justice Center, said he feared that “a lot of frail people are not going to make it on the reduced package.”
The average cost per year for nursing home care nationally is about $80,000.
State officials decided they could raise the level of need for patients to qualify for full long-term benefits, whether in a nursing home or elsewhere. The legislature approved the change in April, as did the federal Centers for Medicare and Medicaid Services.
Under the new regulations, the current requirement – that someone need help with an “activity of daily living” such as dressing or using the bathroom – has been replaced by a complicated weighted point system that makes it considerably more difficult for patients to reach the standard to qualify for nursing home care.
Jesse Samples, executive director of the Tennessee Health Care Association, representing the majority of Tennessee’s 330 nursing homes, agreed [with Bonnyman] that TennCare’s chief motivation is to save money and also agreed with Killingsworth that nursing homes were the target.
“In an ideal world we would increase funding for all categories of services,” Samples said. “But we’re playing a zero-sum game here. In order to get money for home and community-based services, you have to take it from somewhere else. That would be nursing homes.”