Friday, December 10, 2010

Disabled Nevadans could lose aides under state cuts

From the Reno Gazette-Journal:

Meg Procaccini (pictured) was born with cerebral palsy. Unable to move much, the 46-year-old spends her days between her bed and wheelchair in an apartment building for the disabled at William J. Raggio Plaza.

Her Medicaid covers the cost of a personal-care aide, who operates a lift that gets her from bed to chair and back to bed again. The aide means everything to the quality of life she tries to maintain. Coverage of the personal-care aides for more than 6,540 disabled Nevadans is listed among the state Department of Health and Human Services proposed cuts, Director Mike Willden said.

"If they take the aides out completely, I won't be able to get out of bed," Procaccini said. "I will just be in my building alone. If they do these budget cuts and take the aides away from us, I won't be able to live my life."

As part of Gov.-elect Brian Sandoval's $1.2 billion in proposed budget cuts, Health and Human Services will need to trim $200 million from its current budget or $500 million from its requested budget for the 2012-13 cycle. The aides are a big-ticket item, with $53 million requested to cover their costs in the next biennium.

The aides are considered an optional program, not mandated by Medicaid coverage. That is why they are on the list, Willden said.

If Procaccini's aide is eliminated, she probably would not be allowed to stay in her apartment. She would most likely be transferred to a nursing facility where the cost of care would skyrocket. Since beds for Medicaid recipients are limited in Reno-area nursing homes, there's a chance that Procaccini and others could be shipped out of state -- anywhere a Medicaid bed is available.

"You might as well just kill us all now," Procaccini said. "I know that sounds harsh, but it is true, if you take those people away from us."
Her sense of dread is shared by others.

"I call it bureaucratic euthanasia," said Kelli Mosconi, speaking on behalf of her 38-year-old son, Dario, who suffers from spina bifida, a developmental birth defect.

"They take away and take away right down to the wheelchair and ramp for the people who rely on Medicaid," Mosconi said. "And eventually, they are put in a rest home where they eventually die or commit suicide. And basically, in a nutshell, that is our concern."

The Sandoval administration said it is trying to save the aides, even with $1.2 billion to cut, said Heidi Gansert, Sandoval's chief of staff.

"We are doing everything we can to help the most vulnerable population, and we are going over the budget, line by line, to make sure that we do get the services like that," Gansert said. "We want to save them for a couple of reasons. We know they need those services. We also know that you would save money in the short term, but we are looking at long-term savings. So we want to make sure those people don't end up in long-term care."

Willden acknowledged that budget cuts are always a shifting target. Programs considered safe today might be in trouble tomorrow.

"That's not to say that on Christmas Day, I don't get hauled in (to the governor's office) and they say, 'We can't make this thing balance. So what are you going to do?" Willden said.

Then what is cut?

By coming to the rescue of the aides' program, the Sandoval administration may be painting itself and the Department of Health and Human Services into a corner, a leading Democrat said.

If the $53-million program is spared, if Sandoval insists on cutting the general-fund budget by $1.2 billion and if he stands firm on his no-new-taxes pledge, the DHHS will be obligated to find the cuts elsewhere. Those cuts will hit other older and venerable citizens with $53 million of painful consequences, said state Sen.-elect Sheila Leslie, D-Reno.

"The governor's office is backtracking on this (aides) because they have realized that it doesn't makes sense, and I commend them for that," Leslie said. "So OK, you save that (aides) but where is the next $53 million that is going to be cut? Mike (Willden) didn't put that on the list (of potential cuts) because he probably thought that was unacceptable.

"There are just no good choices left," Leslie said. "In Health and Human Service issues, we are going to see this predicament time and time again."
If the aides stay, other optional Medicaid programs are in jeopardy, Willden said.

It brings the debate back to increasing taxes to provide services, despite Sandoval's no-new-taxes stance, Leslie said.

"This is the predicament that he is going to find himself in," Leslie said of Sandoval. "And that is why you see so many legislators, Republican and Democrat, not willing to take taxes off the table. It's because we know the budget. We know there is not $53 million left in HHS (Health and Human Services) that can be cut.

"Those of us who have been working on these budgets for years -- in Sen. Raggio's case, for decades -- we know better. This is exactly what we are going to weigh: Is it worth it to save money, only to spend money later and destroy people's quality of life? I don't think so."

Other optional Medicaid services that will come under scrutiny include the Medicaid pharmacy program ($102 million in savings) and outpatient mental-health services ($61 million in savings).

Other prime multimillion targets could be adult day care, adult nonmedical dental and vision programs, adult free-standing hospices plus programs for adult prosthetics, hearing, occupational therapy, speech therapy and physical therapy.

"All of those are optional services in the Medicaid rules that don't have to be provided by the state," Willden said.

Some advocates are upset that so much of the state's financial burden is to be shouldered by the most vulnerable. Traditionally, the health and human services budget is about 29 percent of the general fund. Combined budgets for K-12 and higher education are about 52 percent.

"I have not seen much leadership from the governor-elect who is talking about shared sacrifice," said Bob Fulkerson, director of the Progressive Leadership Alliance of Nevada. "But I can guarantee you that not one person on his transition team is going to sacrifice a dime. The people who are going to sacrifice are seniors, children who need a good education, people with disabilities, homeless veterans. These are the people whose lives are at risk."

Willden defended Sandoval and the six other governors he's work for in the past.

"I've worked for three governors directly (as head of DHHS) and seven indirectly and I've never met anybody who likes to make cuts," Willden said. "Human services are just tough choices."

The recession and Nevada's nation-leading unemployment has only exacerbated Nevada's problems funding Medicaid programs. Nevada's Medicaid caseloads have shot up 54 percent in the past three years, Willden said.

Nevada has about 276,000 adult Medicaid recipients and about 22,000 children on Nevada Check Up health programs.

Medicaid caseload growth has grown by 3,500 to 4,000 people each month for the past two years, although that growth is beginning to slow.

"We are being overwhelmed because people who used to be employed in Nevada are now unemployed," Willden said.

About 110,000 Nevadans now receive some kind of state or federal unemployment benefit, according to Nevada's Department of Employment, Training & Rehabilitation. The state's nation-leading unemployment rate hovers around 14 percent.

"You can see that changing dynamic in our lobbies," Willden said. "We used to see the chronic disabled and the moms and children needing health care. Those people are still there but now you have whole families, moms and dads who have lost their jobs. There are people who have been making a living for years and years, and now they are not able to make that living and their unemployment benefits are exhausted and they are coming to us for health care and food stamps."

Even in the best of times, Nevada's concern for its most vulnerable has been judged to be among the worst in the nation, Willden said.

"I have said this publicly to every governor and every legislator I have ever served: Nevada is not a generous state when it comes to human services," Willden said. "You don't have to believe me on that. You look at rankings nationally and we are in the bottom 10 percentile. We don't do well in any ranking and there are dozens of them.

"But like others, I have to deal with the reality is that there is only going to be a fixed amount of money, and we are doing our best to balance the budget," Willden said.