Pa. Taking Wrong Approach with Senior Care

By Vicki Hoak, Executive Director of the Pennsylvania Homecare Association, content courtesy of pennlive.com.

As a taxpayer and supporter of measures to curb the commonwealth’s skyrocketing Medicaid costs, I applaud Auditor General Jack Wagner for monitoring Medicaid error rates. I also support Gov.-elect Corbett’s commitment to identifying savings in the Medicaid budget.

As executive director of the state trade association for the home health, hospice and in-home personal care industry, I am compelled to introduce another measure, which is sure to not only curb Medicaid costs but also address the aging population’s cries for better choices in long-term care.

When identifying the reason for skyrocketing Medicaid costs and the $5 billion budget deficit, we must examine Pennsylvania’s poorly constructed and antiquated long-term care system that favors funding for institutionalized care over less expensive home and community-based services.

In Pennsylvania, all citizens are entitled to nursing home care — an entitlement that comes with a price tag of about $58,000 per person, per year to Medicaid. What Pennsylvanians are not entitled to is in-home care — the ability to receive supportive and nonmedical services in one’s own home — the overwhelming choice for seniors and people with disabilities.

In contrast to institutional care, the price tag for in-home care is estimated at $22,000 per person, per year to Medicaid, which is less than half the cost of care in facilities such as nursing homes.

The numbers speak for themselves. So, why does the state encourage Pennsylvanians to opt for the most expensive yet least preferred long-term care option? It is a question that home and community-based service providers have been asking for decades. It is a question every Pennsylvanian should be asking, too.

A report by the Rockefeller Institute of Government’s Health Policy Research Center identifies Pennsylvania as “one of the more generous when it comes to doling out long-term care benefits.” This is true.

Nearly 75 percent of Pennsylvania’s Medicaid expenditures go to institutionalized care. But is this spending “generous” or irresponsible given that homecare spending is proved to be less expensive? Overall, the commonwealth spends only 22 percent of its long-term care budget on in-home services, which is woefully shy of the national average of 40 percent.

It is that spending imbalance on institutional care versus home and community-based services that caught the attention of the federal government, which is incentivizing states with up to six percent more federal matching dollars for increasing their home and community-based services spending ratio. That means an additional $300 million for Pennsylvania.

Pennsylvania’s Medicaid problem also stems from policies that barricade access to home and community-based services. If I am 80 and fall below a certain income level, I am presumed eligible for nursing home care and Medicaid will pay for that care. The same “presumptive eligibility” is not granted to an individual or family who prefer in-home care. Instead, individuals are forced to wait more than a month for in-home care at a time when they need it immediately.

Rescuing Medicaid from financial ruin takes more than auditing error rates or an uptick in the economy. It takes a trans-formative redesign to sustain funding for this vital program. Other states have demonstrated overall savings to their entire Medicaid long-term care budget by providing more in-home care even when they serve more individuals through the redesign.

Pennsylvania must act now to increase availability and accessibility to home and community-based care to individuals who need those services as well as those who pay taxes to support the provision of these services.