Saturday, December 18, 2010

How will trimming of Medicaid costs in NY state affect people with disabilities?

From Newsday:

Whatever Governor-elect Andrew Cuomo decides to do to close New York's multibillion-dollar Medicaid gap, he'd better be ready to deal with New Yorkers like Geraldine Flynn.

"I fight for everything I need," said Flynn, 55, who has cerebral palsy and uses a wheelchair. Medicaid pays for 24-hour-a-day home health aides for Flynn and for the complicated medical care she needs. Money from Social Security pays the monthly rent so she can remain in the family home in Point Lookout while her ailing 88-year-old mother resides in a nearby assisted living center. And it just bought Flynn a new power chair.

"Doesn't mean you get away with anything," said Flynn, who will be moved to Section 8 housing after her mother dies. "Some people think I've got it easy - I don't."

Trouble is, New York State hasn't got it easy these days either.

With federal stimulus aid set to expire next year, intense scrutiny is being trained on the largest single expense driving the budget off a $9.3-billion cliff: Medicaid, on which New York spends twice as much per capita as the rest of the country. Spending on care like Flynn's is soaring even though fewer people are receiving it, noted the Citizens Budget Commission: The cost of caring for a nursing-home patient has gone up 19 percent in the past five years, while personal care services cost 40 percent more and the per-patient cost for certified home health agencies is up 76 percent.

Cuomo, who has vowed not to increase taxes, wants to trim the cost of Medicaid by reorganizing it to eliminate waste and focus spending in ways that really improve health.

"We haven't redesigned the Medicaid program in decades in this state, and now it's time," he told Newsday at an October campaign stop in upstate Delhi.

That's a tall order. New York has the nation's most expansive safety net, one that covers far more services than federal rules require and now stretches to cover 4.7 million people - nearly one in four state residents.

Half of all the babies born in the state are covered by Medicaid. So are three quarters of all nursing home stays. The program not only serves welfare recipients, the disabled and childless indigent adults, but also insures low-income working families, with sliding-scale coverage for children from families earning up to $88,000. And it reimburses hospitals that care for the uninsured. The recession of 2008 and 2009 drove 600,000 people onto the rolls, and federal health care reform is expected to add many more.

"I don't blame people for taking advantage of a program that is available to them," said Lt. Gov. Richard Ravitch, who this fall issued proposals for reform. "I fault all the expansions of Medicaid and child health care that occurred without the government being willing to tax to pay for it . . . The course we're on is not sustainable."

New York's system, created in the 1960s for welfare clients, is saddled with "an unwieldy and overly decentralized structure that serves contradictory goals and provides perverse incentives," Ravitch wrote.

It is the counties that determine who is eligible for Medicaid, but a jumble of different state agencies oversees the various things it pays for - and the legislature controls reimbursement rates, the subject of perennial haggling that helps keep a small army of Albany lobbyists employed.

Lawmakers have made plain they don't intend to give up their rate-setting power. Hospitals, which have seen provider reimbursement rates cut nine times since 2007, warn some of them could go under if those rates drop again. Medical malpractice reform, another long-sought source of savings, has gone nowhere. For now, saving money by reducing eligibility or services is blocked by a moratorium in the federal health care reforms.

Still, "The severity of the state's shortfall is so large that I think more basic questions than we've ever asked have to come to the forefront now," said Sen. Kemp Hannon (R-Garden City).

Cuomo says he'd like to see New York imitate Wisconsin, which last year let health officials and stakeholders decide how to trim 10 percent of the Medicaid budget without reducing care. Those changes, like ending unnecessary Caesarean sections, were accepted by the public with little controversy.

Already the politically powerful health care union 1199 SEIU United Health Care Workers East has begun talks with Cuomo on a proposal it promises will bring "significant savings" by changing the payment model for home health care to predetermined bundles of care based on need, rather than reimbursing providers by the hour.

"The hospital and nursing-home industries are in dire financial condition," warned 1199's political director, Kevin Finnegan. "Any changes . . . have to be dealt with very gingerly."

But Vincent J. Russo, the attorney who helps Flynn with her Medicaid, called the talks in Albany "very concerning. We're seeing difficulty with clients accessing the Medicaid home-care program, and limitations on what they are going to be able to receive."

"I get worried," agreed Peter Belmonte, an airfreight dispatcher whose 85-year-old father was felled by two strokes and has lived for the past seven years in a nursing home on Medicaid. Belmonte's father, a former iron worker who is fed through a tube, is visited daily by his 83-year-old wife, a retired seamstress who remains at the couple's Valley Stream home, living on their pensions and Social Security. Their home was placed in trust to Belmonte and his sister so they can keep it after she dies, rather than having to sell it to pay off Medicaid.

Belmonte doesn't want to see any of these kinds of benefits touched as Cuomo seeks to address the Medicaid budget crisis - a mess Belmonte blames on "poor management."

"We've got a new governor, and I hope he does something about it. If not, he'll have to go too, in four years."