DHS: Let Medicaid aid 2,800 disabled

Enhanced Medicaid funding made available under the 2010 health care overhaul law would allow Arkansas to move 2,800 people with developmental disabilities off a waiting list for home-based services, such as help with daily living tasks, the director of the Arkansas Department of Human Services told lawmakers Thursday.

Some lawmakers expressed concern about the cost of the program, known as the Community First Choice Option, and federal requirements that would come with the funding.

Sen. Jonathan Dismang, R-Searcy, suggested the state might want to delay the program until after a new governor takes office Jan. 1.

Republican Asa Hutchinson and Democrat Mike Ross are competing in the November election to succeed Democratic Gov. Mike Beebe.

"We would like to do something with the 2,800 people who are on the waiting list," Dismang said. But he added, "We want to make sure we do it in the Arkansas way that's best for us."

Created by the federal Patient Protection and Affordable Care Act, the Community First Choice Option allows states to receive a 6 percentage-point increase in the level of federal funding they receive to provide in-home care to the elderly or disabled.

If Arkansas implemented the program, the federal government's share of the cost for the services would increase from 70 percent to 76 percent.

Arkansas' share of the costs would fall from 30 percent to 24 percent -- meaning its costs would drop 20 percent.

In exchange, the state would have to eliminate its waiting list and serve all qualified applicants. But the increase in federal reimbursement would more than offset the cost of serving more people, Human Services Department Director John Selig said.

Arkansas submitted an amendment to its state Medicaid plan to the U.S. Department of Health and Human Services' Centers for Medicare and Medicare Services in January that would allow it to implement the program, but the federal agency has not yet given its approval, Selig said.

The Human Services Department could submit rules implementing the program for the Legislature to review as early as November, and the program could start early next year, he said.

The state's spending on home- and community-based services in the fiscal year that ended June 30, for about 14,000 people, totaled about $121.7 million. Even without implementing the Community First Choice Option, that spending is expected to rise to $274.2 million by 2026, according to figures the Human Services Department presented to lawmakers.

With the increased federal match, the growth in state spending would be slower, reaching only $208.2 million, according to the figures.

Over the 12 years, the department projects that the state would save $365.5 million.

And, Selig said, those savings don't account for money the state would save by allowing more people to receive care in their homes, rather than in nursing homes or other institutions.

"We would not be proposing this program to you if we thought it was costing us money," Selig said.

Selig added that even without the enhanced funding, the state could be forced to eliminate its waiting list if someone on the list filed a lawsuit alleging that his rights were being violated.

That happened in 2003, when Mark George sued the Human Services Department in federal court after his daughter, then 5, was placed on a waiting list for home- and community-based services.

George said in the lawsuit that the state violated a federal law requiring eligible applicants in states that provide care in both institutional and community-based settings to have a choice between the two types of care.

As a result of the suit, which was settled, the state eliminated the waiting list by increasing the cap on the number of people it serves, Selig said. The need has continued to grow beyond the limit set in the state's cap, he said.

"Basically, what you're recommending is a lawsuit avoidance policy," said Rep. Nate Bell, R-Mena.

Bell said he doesn't want to add to the federal deficit and is concerned about the overall cost of serving more people, regardless of where the money comes from.

He said the savings cited by Selig are "like my daughter coming home and telling me I got this lovely pair of jeans at 50 percent off, so I saved you a lot of money."

"There was still money spent," Bell said. "The federal money that's being spent is not free."

Including the cost to the federal government, serving the people now on the waiting list would cost about $112 million a year, Selig said.

Wearing green stickers with the message "Support people with disabilities," advocates for Community First Option Choice filled the available seats in the meeting room at the Multi-Agency Complex near the Capitol, with others standing along the wall at the back of the room.

Teresa Dodson, whose 14-year-old son has autism and other developmental disabilities, said her son has been on the waiting list for seven years. About 130 people are on the list ahead of him, she said.

She said she gave up a 15-year career in insurance and took a lower-paying job so she could spend more time taking care of her son. She said he has the mind of a toddler and "still throws temper tantrums like a 2-year-old."

"I can't even go out to eat with my husband," Dodson said. "I no longer go to church because I have to stay home with my son while the remainder of our family attends church services."

Selig said those now coming off the list have been on it for eight years, and the wait for many will be longer than that.

Those who spoke in favor of Community First Choice Option included representatives of AARP Arkansas, the Developmental Disabilities Provider Association, the Arkansas Association of Area Agencies on Aging and several advocacy groups for the disabled.

Rep. Josh Miller, R-Heber Springs, said helping people stay out of institutions would save money for both the state and federal governments. He said the community-based services would help disabled people find jobs and noted that last year, the Legislature approved expanding eligibility for Medicaid to an estimated 250,000 adults with incomes of up to 138 percent of the poverty level.

Those who became eligible for coverage under the expansion are "able-bodied," said Miller, who voted against the expansion.

"What we're dealing with here is the non-able-bodied population," Miller said. "While I appreciate many of my colleagues' conservatism, I would venture to say maybe we are exercising it on the wrong people."

George, who filed the lawsuit in 2003 to get his daughter off the waiting list, said access to supportive services has given his daughter a chance to dance, ride horses and play soccer.

"It's not Obamacare," he said. "It's human decency."

A section on 08/29/2014

Upcoming Events