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The budget passed by the Senate last week would cut funding for Medicaid services that keep people in their homes. Advocates came to the legislature to express their disapproval.
By Rose Hoban
About a hundred seniors and people with disabilities and their advocates descended on the General Assembly to buttonhole legislators over proposed Medicaid cuts passed in last week’s Senate budget.
Red-shirted groups of people crowded the doors of House members asking them not to concur with the Senate budget and asking them to restore cuts to the state and county special assistance program that provides services to thousands of seniors and people with disabilities who live in adult-care homes and receive in-home assistance that’s subsidized by Medicaid.
As proposed in the budget the Senate passed after midnight Friday, anyone who has an income totaling more than 100 percent of the federal poverty level ($11,670 for one person) would be moved off of Medicaid and onto the federal health insurance marketplace created by the Affordable Care Act.
Lou Wilson, who lobbies for the N.C. Association, Long Term Care Facilities, said that would force the expulsion of about 5,200 people from facilities around the state.
“Our homes will have no choice but to discharge those persons, and, quite honestly, we don’t know to who or to where,” Wilson said. “The people living in our facilities, many don’t have a home to go back to; many of them don’t have families …
“This will leave these folks without Medicaid, without money to buy medications, without money to see a doctor, without money to pay hospitals, and will leave the facility without any Medicaid funds to pay any staff to help provide those essential services those folks need on a daily basis.”
An additional 3,057 people receive Medicaid special assistance for in-home services; many of those people would also lose their Medicaid under the Senate plan.
Wilson also pointed out that in the past seven years the number of people who are receiving special assistance in adult-care homes has dropped from 29,600 to 24,400 residents.
“I can’t believe that all this activity is because someone is concerned about too many people qualifying for special assistance,” she said. “I was absolutely shocked. Who would ever believe that the Senate was down here going behind the door talking about putting some of North Carolina’s oldest and most vulnerable citizens on the streets?”
More elderly, less money
According to statistics compiled by the Department of Health and Human Services’ Division of Aging and Adult Services, 39 North Carolina counties currently have more residents who are over 60 years old than residents who are under 17. By 2025, that number is expected to grow to 89 counties with more seniors than children.
Joan Pellettier, director of the Area Agency on Aging at the Triangle J Council of Governments, said more than a quarter of seniors in the state have two or more physical or mental impairments that make it difficult to live entirely on their own.
“Family caregivers provide at least 80 percent of long-term-care services to older adults in North Carolina,” Pellettier said. “Those caregivers need support. The average length of their caregiving role is eight years.”
But another part of the Senate budget would trim the Home and Community Care Block Grant, which funnels money to programs such as Meals on Wheels, adult day care, transportation and respite for families providing long-term care.
“Without these services, many seniors would require more restrictive and more costly care,” which would likely be paid for by Medicaid, Pellettier said.
Already this year, more than 16,000 people are on waiting lists for block grant services. Of those, 10,500 are waiting on services for people that serve the homebound, such as Meals On Wheels and in-home aide services.
The nearly $1 million in proposed reductions could cut services for 1,500 vulnerable individuals struggling to remain as independent as possible for as long as possible, Pellettier said.
One of those on a waiting list is Joanne Wood’s 91-year-old mother-in-law who lives in her own home in Wilson. Wood said she, her husband and stepson help her mother-in-law to stay independent.
“Without Meals On Wheels, she would have long ago been placed in an assisted-living or a nursing facility with the assistance of Medicaid,” Wood said.
She said her mother-in-law is on a waiting list for in-home care, and the agency managing the care does not know if it will be able to serve their current waiting list, much less more recent additions.
Medicaid in North Carolina pays on average $4,712 per month for nursing home care.
“Do the math,” Wood said. “Keeping the program saves Medicaid dollars by keeping seniors in their homes and not in expensive care facilities with Medicaid funding.”
Advocates for people with developmental disabilities have also expressed concern about what the Senate budget would do to those populations.
“The idea that any group would be considered optional by leadership in the Senate was appalling,” said Julia Adams, lobbyist for the Arc of North Carolina, an organization that serves thousands of people with developmental and intellectual disabilities.
Under the current special assistance arrangement, a Medicaid recipient could use the combined state and county funds to supplement disability payments in order to live in group homes, even if they make too much income to qualify for Medicaid.
“What this budget does is, it decouples Medicaid eligibility and special assistance eligibility,” said Adams. “We’re finding now in some of our group homes that people are no longer going to qualify for special assistance funding, which means they will no longer receive payments that allow them to stay in their homes.”
Adams said her organization is calculating exactly how many of the people the Arc serves would be affected, but she said some of her group homes are reporting that half of their residents’ placements would be in jeopardy.
Other residents in Arc homes are old enough to qualify for Medicare and are “dually eligible,” meaning that they also qualify for Medicaid to pay for what Medicare does not cover. Adams said those people who might earn enough to be pushed off Medicaid would actually not be eligible for insurance from the exchange because the Affordable Care Act does not allow people on Medicare to buy insurance from the online exchange.
“The ACA is kind of specific; if you’re over the age of 65 and you’re Medicare eligible, then you have to go on Medicare. And if you don’t have enough work credits, you have to buy Medicare Part A, which is $441 a month,” Adams said. Right now, Medicaid pays for that extra money for the dually eligibles.
Duke University health economist Don Taylor said the Senate proposal for moving people onto the insurance exchange is unrealistic.
“What insurance company is desperate to cover a whole bunch of 85-year-olds?” he said. “They’re expensive.”
Taylor also expressed exasperation at the vagueness of the Senate’s proposals for Medicaid.
“Saying how much we hate the ACA for three years, and then this proposal is so vague that you can’t tell what it is?” he said. “The only clarity is that you want the least eligibility possible for people who are elderly, blind and disabled.”