Facts about Medicaid in Washington
• 1.2 million residents use Medicaid (47,000 of them are in the in-home care program).
• Unlike Medicare, designed largely for people 65 and older, Medicaid serves the community’s poorest sector. In Washington, an individual with a monthly income of no more than $674, or 74 percent of the federal poverty threshold, qualifies for Medicaid. (There are waivers for high-needs residents who have monthly incomes up to $2,022.) Eligibility differs by state, as each state administers its own program under federal oversight.
• Children represent about two-thirds of Medicaid patients, but the program also has a focus on elder care. That’s where in-home care comes in. Washington state has chosen to use Medicaid funds, when possible, to provide care at home for people who otherwise would be in a nursing home, adult home or assisted-living center.
• A recent economic analysis indicates federal reductions to Medicaid proposed by Congressman Paul Ryan would cost the state up to 28,000 jobs, according to the nonprofit health care advocacy group Families USA. The proposal would provide Medicaid funding through block grants and reduce federal contributions by 5 percent in 2013, 15 percent in 2014 and 35 percent by 2021. Third Congressional District Rep. Jaime Herrera Beutler, R-Camas, voted for the proposal when the House approved it in April. The Senate has not acted yet, but U.S. Sens. Patty Murray and Maria Cantwell of Washington are part of a Democratic bloc opposed to any Medicaid cuts.
After a monthlong convalescence in a skilled-nursing facility, 67-year-old Sandra Morgan relishes every day she spends at home.
Four years ago, complications from a surgery to remove cancer landed Morgan in Vancouver’s Heritage Health and Rehabilitation Center. (It closed in 2007 to make room for the state Highway 500 and St. Johns Road interchange.)
“I had visited a nursing home before, but you have no idea what it’s like until you’ve been there,” Morgan says. “People are in different stages of life and death. One lady screamed into the night.”
There was no privacy. Morgan says she had to use a chamber pot to relieve herself and never had the luxury of washing her hands because the staff was too busy to help her. Showers happened just once a week when she was hosed down in her wheelchair, and the food was hard to stomach, she said. Morgan remembers being served a cup of orange juice laced with a thickening agent as a precaution against choking.
“It was a miracle to get to come home,” Morgan says. “It was an answer to a prayer.”
Morgan says her savior was a state Medicaid-funded program that pays for low-income patients to receive a caretaker at home for a set number of hours instead of living at a skilled-nursing facility. The state pays her niece, Debi Wear, for about 140 hours per month to assist Morgan in meal preparation, cleaning, shopping and other tasks Morgan can’t manage alone. It’s also one of the many programs nationwide that could be at risk under a pending proposal by Congressman Paul Ryan, R-Wis., to reduce the federal government’s share of Medicaid spending.
Without in-home care, Morgan, who lives on less than $700 per month of Social Security, would likely have to live in a higher-cost assisted-living center funded by Medicaid.
The $1 billion in-home care program, serving about 47,000 clients statewide, is estimated to save taxpayers $300 million per year in higher-cost stays in assisted-living or nursing homes, according to the Washington Department of Social and Health Services. The state is mandated by the federal government to provide assisted living to Medicaid patients who need it. It provides in-home care as a money-saving alternative that most seniors prefer, says David Kelly, executive director of the Southwest Washington Agency on Aging and Disabilities, which serves about 3,200 in-home care clients in Clark, Cowlitz, Wahkiakum, Klickitat and Skamania counties.
It costs an average of $3,790 per month to keep a patient in a nursing or assisted-living facility, compared to an average of $1,426 per month for the patient to remain at home and receive time with a caretaker, Kelly says.
While most people may prefer in-home care, it’s not for everyone, especially those who need around-the-clock care, says Gail Haskett, a gerontologist and owner of Vancouver’s Aging Resources Inc.
Haskett says for some seniors, assisted-living centers can offer socialization that might be absent at home. Others may place more value on having the autonomy that comes from living in their own home, or they may already have the socialization they need around them, she says.
The $1 billion annual cost of the in-home program includes case managers and caretakers, says Bill Moss, state director of Home and Community Services.
In 2009-2011, the state picked up about 37 percent of that cost, and the federal government reimbursed the state for about 63 percent. This biennium, which began July 1, the state assumes 50 percent of the cost and receives 50 percent reimbursement from the federal government, Moss says.
As part of a broader $5.3 billion state budget shortfall, the state Legislature reduced its overall Medicaid spending this biennium, which began July 1, by about $852 million. That includes both state general fund dollars and federal reimbursements and covers a number of services besides in-home care. Most optional Medicaid programs were either eliminated or reduced, including in-home care. The state made about $98 million in reductions to the in-home program, says James Kettel, DSHS chief forecast manager.
For the average client, that meant a 10 percent reduction in caretaker hours, Moss says. Hours were subtracted based on each client’s need, he says.
Jean Prew, 90, who receives in-home care in Vancouver, lost less than the average, about five hours of her 120 hours per month, she says, but she lost another 13 hours earlier in the year as a result of cutbacks. Prew says she hasn’t noticed a difference in her care since the reduction because her caretaker, Jean Bray, often spends more time with her than what she’s paid for. But the reductions meant a small pay cut for Bray.
“I don’t mind because it’s Auntie,” Bray says, using Prew’s nickname. “I told her I’d be with her for the long haul.”
Prew says she joined the program after she fell and broke her kneecap two years ago.
“It curtailed my activity fiercely,” Prew says. “I was pretty active until then.”
Bray helps Prew into the shower and makes sure she doesn’t fall. She fixes Prew’s meals and does all the housekeeping. She also does the shopping either alone or with Prew, who gets around on a power wheelchair.
“She does all the things I used to do,” Prew says.
Prew says she can’t stand the idea of moving to an assisted living center or nursing home.
“I wouldn’t survive there,” she says. “I’m very alert. No way. I’ve been terribly independent all my life.”
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