Medicaid ax hangs over state’s frailest

Estimates say if cuts occur, 15,000 stand to lose nursing-home care

Jeanne (left), 71, who doesn’t want her last name used, suffers from a number of ailments and lives alone in North Little Rock. She is dependent on her caregiver, Tracy Armstrong (right), and the regular nursing visits paid for by Medicaid.
Jeanne (left), 71, who doesn’t want her last name used, suffers from a number of ailments and lives alone in North Little Rock. She is dependent on her caregiver, Tracy Armstrong (right), and the regular nursing visits paid for by Medicaid.

— Nursing homes across Arkansas will close if the state eliminates Medicaid funding for Level 3 nursing care, Department of Human Services officials, advocates and nursing-home industry officials say.

With thousands of frail patients — most of them elderly — denied services, as many as 90 nursing homes would be shuttered, a nursing-home industry official says.

In all, as many as 15,000 people — about half of whom receive nursing care at home or at day centers — will be stripped of that care and will be forced to rely on relatives or themselves, instead.

“It would be catastrophic,” said Sen. David Johnson, a Little Rock Democrat.

Gov. Mike Beebe and administration officials like Medicaid Director Andy Allison have said the cuts could be avoided if the state expands Medicaid by 250,000 people. Expansion would mean extra federal funding and extra tax revenue, they argue. Some Republicans are skeptical. They say they’re reluctant to commit the state to a decades-long, multibillion-dollar expansion that will eventually consume hundreds of millions of state tax dollars.

Many also say the money to resolve an estimated $138 million deficit can be found elsewhere in the budget without resorting to forcing people out of nursing homes. Allison has said the cuts are the least painful option if additional money isn’t available.

Jeanne, a 71-year-old woman living alone in North Little Rock, is one of those thousands of Arkansans who receive Level 3 care through Medicaid.

Osteoporosis has contributed to broken bones in all four of her limbs. She’s had multiple back surgeries and is currently nursing a fractured pelvis.

She also has chronic obstructive pulmonary disease and asthma.

She’s a former hospital worker who says she “never asked anyone for a dime” in her life, but now she receives about six hours of daily care and regular nursing visits paid for by Medicaid, a state-federal partnership that provides health care to the disabled, lower-income children, pregnant women and the elderly.

Almost all recipients have little or no income and few assets.

Medicaid pays for the type of Level 3 nursing care that Jeanne receives. To qualify for Level 3 care, recipients have to spend down their savings to a $2,000 cap for individuals and $3,000 for couples, and need assistance in feeding, walking and other basic needs.

“I need somebody to come in. If I didn’t have Tracy [her home-health-care worker] to come in ... I just don’t know what I’d do, it’s hard to think about,” Jeanne said.

Jeanne, whose last name was withheld from this article at the family’s request, has a ready smile and loves to bake.

One recent morning, her home-health-care worker, Tracy Armstrong, helped her flip through recipes, deciding on a sweet concoction to send to her son, who is working as a contractor in Afghanistan.

Armstrong helps Jeanne cook, clean, dress and bathe. But Armstrong’s services will disappear if the Arkansas Department of Human Services follows through with plans to cut $329 million from the Medicaid budget over the next two years. The reductions are designed to fill the fiscal hole in the program that covers 780,000 Arkansans.

“The general public has a misconception about who receives Medicaid services,” said Elaine Eubank, CEO and president of Care Link, a North Little Rock nonprofit that coordinates care for senior citizens who want to live at home.

Many people think the state’s elderly have their nursing care paid for by Medicare, Eubank said. But the federal health-care program for senior citizens doesn’t pay for that, Medicaid does.

From 40 percent to 45 percent of the state’s 18,180 nursing-home residents receive Level 3 care. About 75 percent of people receiving home-based or communitybased care depend on Level 3 funding, according to the Human Services Department.

Jim Cooper, who owns a company that provides administrative services to nursing homes, said smaller, rural nursing homes will be hardest-hit by the cuts. And some rural, sparsely populated counties might lose all of their nursing homes.

“If you have 70 patients, you’re already borderline at keeping your doors open. If you take away 25 to 30 patients, those doors shut,” Cooper said. “It’s going to kill those counties.”

The closures could have a ripple effect, affecting nursing-home patients classified as Level 1 and Level 2, who require more intensive care. Residents from rural areas might be forced to seek care in larger metropolitan areas. And because Level 1 and Level 2 care is federally mandated, the lack of access to that care in rural areas could invite federal scrutiny.

“You’ll have the federal government looking down your throat because you’re not providing access for this population,” Cooper said. “It puts the entire Medicaid program in jeopardy.”

The Department of Human Services estimates that the Level 3 population is split evenly between nursing facilities, and home or community-based care. The proposed cuts would eliminated $119 million for nursing homes and $24 million for home and community-based care over two years beginning in July 2013.

Allison said the federal government would probably delay implementation of the cuts until early 2014.

Jeanne doesn’t know how she would survive without Medicaid. Her four children are scattered around the world and, logistically, she says, none of them can easily take her in if she loses her home-health care.

“I’d have no clue. I just don’t. How can they do that? There’s just so many people dependent on it,” she said.

Charlotte Rogalla, a nurse who regularly checks on Jeanne, said the care Jeanne receives is critical.

“If she falls again, she could break something,” Rogalla said. “It’s a good service, and they need it.”

At a legislative hearing in November, Allison called the $143 million in planned cuts over the next two years “awful, but realistic.”

Even with the cuts, the $5 billion program’s cost is expected to grow to $5.2 billion next year, mostly because of rising medical costs.

The cuts would be avoided if the state expands Medicaid to individuals making up to 138 percent of poverty as authorized by the Patient Protection and Affordable Care Act, supporters say. The federal government pays the total cost for expansion until 2017. By 2020, the state would be responsible for 10 percent of the cost.

Expansion would net $159 million for state coffers by 2015, the Department of Human Services estimates, removing the need to cut Level 3 nursing care.

Some Republicans have been skeptical of the Department of Human Services’ plan, sensing political brinkmanship. But Allison has said his agency has no other option for filling the fiscal hole. Federal law prohibits cuts in many programs, and other cuts would have created greater costs down the road, he recently told lawmakers. The administration also ruled out cutting programs that serve children. Most of those programs are protected under federal law anyway.

The Arkansas Health Care Association and Arkansas Assisted Living Association, which represents 275 facilities in the state, said in a statement that it “takes the challenge the state is facing very seriously.”

“We have full confidence in the governor and legislative leadership, and are willing to work together to resolve this matter,” said Donna Freel Childress, the group’s executive director.

Eubank said her organization plans to lobby strenuously during the legislative session, which begins in January.

“We’re going to fight this hard,” she said.

Johnson, the state senator, said he is confident that the cuts can be averted.

“I can’t help but think that the case for preserving Level 3 nursing care is so great, it’s so compelling. I just can’t imagine that any legislator could permit that to happen. I don’t care who it is — Democrat, Republican,” Johnson said.

Rep. David Meeks, a Conway Republican, said he isn’t convinced that the cuts are necessary.

Waste can be cut and new sources of money can be found to fix the problem, he predicted.

“There is money out there,” he said.

Beebe is committed to finding some way to avoid the cuts, either by expanding Medicaid or finding other sources of revenue.

“Of all the cuts announced, that’s the one that concerns the governor the most, and the one he is most dedicated in trying to prevent,” his spokesman Matt DeCample said.

Rep. Tim Summers said he “cannot perceive of a situation where we would turn people out of a nursing home.”

The Bentonville Republican, who lost in his state Senate primary bid and won’t be returning to the Legislature next session, said he hopes that the announced cuts aren’t a “ploy to bring about the expansion of Medicaid.”

DeCample said it is an understandable “political instinct” for some people to react to the cuts as part of a political strategy but the Beebe administration has no other alternative.

Cooper, also a board member at the Arkansas Health Care Association, said he and other nursing-home administrators and operators have been flooded with calls from worried people, who have read about the proposed cuts.

Administrators have been counseling the worried callers to remain calm, he said. He said he knows that the state budget is tight, but he hopes a solution can be found. If not, he said, Arkansas will be in for a shock next year when thousands of people unable to function on their own are forced to try.

“They’ll fill up the emergency rooms and hospitals,” he said.

Front Section, Pages 1 on 12/16/2012

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