So You Want to Cut Medicaid. Do You Really?

With its history of anti-tax Republicans, tax-fearful Democrats and bowing to corporate extortion to keep jobs in the state, Illinois has underfunded pensions, unpaid vendors and health care providers, and has many other economic woes. So, once again, Medicaid has become a target. Medicaid is often on the chopping block, probably because the perception is that it helps poor people. Now, the lingo is that the cuts being made are to save the program. No need to change priorities.

What exactly is Medicaid? It's a joint federal-state program, basically, the national health care safety net for the poor, children, the disabled and seniors, but administered separately by each state.

Who pays for Medicaid? Medicaid is a joint federal state program. The federal government has traditionally contributed over half of the needed funds to the various state Medicaid programs, but federal funds have been disappearing. There was a federal reprieve in the 2009 stimulus bill, but now those funds are gone. So, the states have to make it up. More federal cuts are planned.

What does the House Budget do to Medicaid? Right now, there is no cap on Medicaid spending. The program is based on need and eligibility. The House budget favored by Republicans including Illinois Tenth  Congressional District Representative, Bob Dold, turns the program into a block grant that limits the amount of federal funds to a lump sum each year, subject to decreases as the political winds blow, and requires the states to make up the rest. The block grant proposal would cut Medicaid by one-third by 2022. To make up for the lost funds, the states would be given new flexibility to cut the number of people eligible, cap the number of eligible people who get the benefit, and cut the actual amounts paid out for the benefit of eligible and covered individuals.

What does Illinois Governor Quinn's Proposal Cut regarding Seniors and the Disabled in Nursing Homes or Supportive Living Facilities? The detailed list of proposed cuts can be found here. Because my focus is usually on the elderly and disabled in nursing homes or supportive living facilities, I'll detail some of those cuts here:

• Changing the Determination of Need (DON) for nursing and supportive living facility applicants. The DON is a two-part test that measures symptoms of mental functioning such as memory loss and the need for assistance with activities of daily living (ADL). ADL is a medical and legal term of art that includes bathing, dressing, grooming, toileting, dental care, transferring (getting around the house or from the house  to the car or elsewhere), cooking, laundry, other housework, shopping, managing money and all the things we all do every day to take care of ourselves. The DON also includes a measurement of how well needs are met through other programs (noting that Illinois is way down on the list of states that provide programs to assist people at home). The proposal increases the DON from 29 to 37. Here is an study by the Illinois Department of Aging that describes how the DON is scored and what the scores mean. The change could operate to eliminate people with moderate dementia. or people without dementia, but a moderate to severe problem with motor skills.
• Repeal law requiring ambulance service between hospitals and nursing homes.
• Moratorium on new admissions to intermediate care nursing facilities--about 15,000 mentally ill people will find no place to live.
• Eliminate mental health programs for nursing home residents.
• Eliminating bed holds for nursing home patients temporarily transferred to the hospital.

What does all this mean to the average Illinoisan? If you're ok with Medicaid cuts because you're not poor or feel the poor get too many benefits at your expense, think about this: As was pointed out by one of the providers who does needs evaluations for the state here, the changes would make the average 65-year-old incontinent woman with cataracts and arthritis who needs help with cooking and taking medications ineligible for nursing home or supportive living assistance.

Do you have a member of your family who is elderly or disabled? Do you think you will always be able to take care of that person at home? Do you work? Would you have to keep your elderly and/or disabled loved one alone for long periods of time each day? Can you afford in-home daytime help without state assistance? What would the home look like if your elderly or disabled loved one was left to his or her own devices all day? Would medications be taken as directed? Would reasonably nutritious meals be made? Dishes washed? Would you be worried about the senior or disabled person setting the house on fire? Forgetting to lock doors or opening doors to strangers? How do you feel about changing adult diapers? Would your parent feel demeaned by having you, his or her child, changing the diapers? What if the only person able to be at home was one of the grandchildren? Ok if it's a 20 year old? How about a 16 years old?

Ever have to get the nursing home to send grandma to the hospital? I did several years ago when I was young and unaware of Medicaid rules. My grandmother became very ill one day when I happened to visit. She was so ill, I became alarmed, and we called an ambulance to take her to the hospital. There was no way I could have managed her in my car, so I felt lucky that there was available ambulance service. Turned out that she was in fact quite ill. She was in the hospital for several days, but what were we forced to worry about? That she'd lose her room at the nursing home. I had no idea that I might have risked her room, and it didn't really matter because she was too ill for me to ignore the issue for Medicaid rules. Turned out that I was lucky because there were limits to how few days the room could be empty before the home would have pushed her out. What will happen to people in similar situations when the limits are removed? Could my family have afforded the daily nursing home rate, about $60K each year then? Could yours? Remember it's probably more now.

What if you're the person who becomes disabled or grows elderly and infirm? Do you think you'll be able to keep your home, health or dignity without assistance? How will you feel about asking your children if you can move in and if the grand kids can give you the 4:00pm diaper change?

Do you think perhaps the country needs to change its priorities away from tax cuts for the wealthiest people and corporations, and unending war, so that seniors and the disabled can be adequately cared for?