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Consumers, workers, and other stakeholders in the Illinois nursing home industry are voicing their opposition to a proposed 18 percent cut to the state Medicaid program.

Details of the potentially devastating round of cuts began to emerge on April 19. According to published reports, Governor Pat Quinn (D) wants to slash Medicaid rolls by 215,000 while lowering Medicaid reimbursement rates for doctors, hospitals, and nursing homes.

Quinn’s plan would save the state $2.7 billion.

A Quick Response

Nursing home stakeholders responded immediately to the threat. The Health Care Council of Illinois (HCCI), an organization representing nursing homes, scheduled a 17-stop protest tour to speak out against the cuts. HCCI held rallies in Rockford and Chicago during the weekend of April 21-22.

If enacted, the drastic Medicaid cuts would cause thousands of elders to be kicked out of their nursing homes, according to HCCI Executive Director Pat Comstock.

“What will happen to some of these residents is that they may not be able to stay here. They may lose their home,” Comstock told WBBM, a Chicago-area television network.

Report Shows Folly of Cuts

On April 25, the Campaign for Better Care and Families USA released a joint report (pdf) documenting the economic toll Quinn’s cuts would take on Illinois.

The report finds that the proposed $2.7 billion worth of cuts to Medicaid would put more than 25,000 jobs at risk and cost the state $3.3 billion in economic activity.

Many of those imperiled jobs would be in the nursing home industry, the report says.

“Cuts could mean jobs lost for [nursing] facilities’ employees, such as aides, nurses, pharmacists, and facility maintenance and management staff,” the report states. “Inadequate staffing lessens the quality of care that facilities are able to provide.”

– by Matthew Ozga

The Alabama House of Representatives passed a Fiscal Year 2013 Budget on April 10 that slashes the Medicaid program by 30 percent — $175 million — which would result in a Medicaid budget of $400 million if the proposal is signed into law.

More than 900,000 Alabamians depend on Medicaid for their health care coverage, including many direct-care workers.

Don Williamson, M.D., who heads up the Alabama Department of Public Health and has been charged with overseeing a Medicaid Task Force, said that “the agency may be forced to reduce payments to doctors, hospitals, and other health providers that serve Medicaid patients.”

Williamson is seeking ways to cut Medicaid programs while at the same time complying with federal Medicaid requirements. However, he has been reported to say that the “proposed budget would not only lead to cuts to optional services, but cuts to programs mandated by the federal government.”

For every $1 that Alabama spends on Medicaid, the federal government matches it with $2, compounding the state’s Medicaid budget loss.

“I don’t think there’s any way in the world any human being can make this budget work at $400 million without serious cuts to someone,” Williamson said.

Will Mean Job Losses

“If nursing homes and other medical-related facilities are forced to make cuts, that will mean job losses,” SalLee Sasser-Williams, an Alabama nursing home owner, told the Andalusia Star-News.

In the meantime, the Star-News reports that Williams is “looking for small cuts that don’t affect patient care” and depending on volunteers to take on tasks such as resident activities, which “frees our activities director to do other things.”

The Alabama Nursing Home Association issued a statement saying that, “We agree with Dr. Williamson that current budget figures for the next fiscal year will make it virtually impossible to avoid serious cuts in the access to care and the quality of care delivered. As Dr. Williamson observed, some of the cuts we may face could mean life or death for many.”

Alabama Governor Robert Bentley (R), a physician, is opposed to raising taxes or other revenue, including increasing the cigarette tax, a measure supported by the House Democrats.

The proposed cuts come on top of a recent 10.6 percent across-the-board budget cut to the state’s General Fund this fiscal year.

“Medicaid cuts this severe will hurt families, health care workers, and many direct-care employers at a time when families are already hurting economically,” said Carol Regan, PHI director of government affairs. “Advocates at the state and national level must continue to protect American families and fight for a strong safety net.”

– by Deane Beebe

Nearly 22,000 Pennsylvanians who participate in the state’s consumer-directed care program — and the workers who care for them — face an uncertain future if a plan promoted by state government officials comes to fruition.

Currently, Pennsylvanians who are elderly and/or have a disability can choose to hire home care aides. The workers’ wages are paid for by Medicaid waivers, and the clients who hire them are considered their employers.

Intermediary entities known as financial management services (FMS) providers, meanwhile, issue the aides’ paychecks, purchase workers compensation insurance, and handle other accounting tasks.

In January, however, state Department of Public Welfare (DPW) secretary Gary Alexander announced a plan to drastically consolidate these providers, reducing their total from 37 to no more than three, and perhaps just one.

Last year, the passage of the controversial Act 22 gave DPW the authority to make sweeping changes to the FMS system without the usual regulatory oversight by the state legislature.

Alexander’s move is part of a broader campaign by the administration of Governor Tom Corbett (R) to curtail state spending by cutting funding for many programs that benefit low-income Pennsylvanians. More than 80,000 children have been cut from Medicaid rolls since last August, and a Corbett-endorsed plan to subject food stamp recipients to an asset test was scaled back only after widespread public outcry.

“Centralizing the FMS system is counterproductive to the ideal of consumer-directed care,” said Joe Angelelli, director of the Health Services Administration program at Robert Morris University and a former PHI Pennsylvania Policy Director. “A more networked and localized approach is more person-centered and effective.”

– by Matthew Ozga

To help fill the $9.2 billion gap in California’s 2012-2013 budget, Governor Jerry Brown’s (D) budget proposal includes cuts of $163.8 million to the In-Home Supportive Services (IHSS) Program by eliminating domestic assistance — such as meal preparation, food shopping, laundry, and housework — for clients who reside in the same home as their caregivers.

The IHSS program provides personal care — including help with bathing, dressing, toileting, and feeding — and domestic services to about 435,000 low-income elders, the blind, and people with disabilities who live in their own homes but are at risk for nursing home placement without the services and supports that the program provides.

About 60 percent of IHSS clients would be affected should the proposed cuts take effect at the start of the new fiscal year on July 1, according to an article in the Sacramento Bee.

The caregivers, many of whom are family members, receive hourly wages and benefits between $8 and $14.78, reports the publication.

Cuts Deemed “Unwise”

Calling the proposed cuts to the IHSS “unwise,” a Los Angeles Times editorial says that “Slashing or ending that care means people in need will have to go to nursing homes, which can also be on the state tab but are more expensive.”

“The general public does not understand how easy it is to end up in a nursing home because it is the only place where care will be provided,” explained San Francisco IHSS Public Authority Executive Director Donna Calame, who is also a PHI board member.

“Sometimes, the simple acts of assisting someone with food shopping and preparation are all that keep a person well nourished and out of a hospital or nursing home. For a very few number of hours per IHSS consumer per month, California will not be saving very much money with these cuts and is risking much higher public expenditures for care in an institution.”

The state’s share of the IHSS Program costs is projected to be about $1.4 billion for 2012-13; the remaining costs are covered by state and county funds, reports the Sacramento Bee.

“There is an institutional bias in public funding of long-term services and supports,” Calame said. “IHSS advocates certainly hope the legislature will reject this proposal from Governor Brown.”

Brown has also proposed closing the budget gap by increasing revenues through a temporary half-cent sales tax increase and imposing higher taxes on the rich. A ballot measure which will be voted on in next November’s election will determine whether these proposals will become effective.

California had planned to cut the IHSS Program services by 20 percent beginning on January 1, as part of automatic, midyear across-the-board cuts enacted to offset tax revenue shortfalls. Disability Rights California filed a suit contending that these cuts violated the Americans with Disabilities Act, and a U.S. District Court judge ruled to temporarily halt them.

– by Deane Beebe

Contract negotiations between Oregon and the union representing home care workers there have stalled over a state proposal to substantially raise the eligibility requirements for aides to receive health insurance.

A bargaining team led by Oregon Gov. John Kitzhaber (D) wants to require home care aides that provide Medicaid-covered services to low-income elders and people with disabilities to work 130 hours a month for three consecutive months in order to qualify for health benefits. Currently, aides must work 80 hours for three straight months.

The increase in hours would cause 2,000 of the state’s 12,000 home care aides to lose their benefits, according to the Service Employees International Union (SEIU), which represents the aides.

In late December, negotiations between the state and the union reached an impasse, largely because of the insurance issue. Discussions between the two sides will re-open next month.

On January 18, a group of about 100 home care workers staged a protest against the cuts in Kitzhaber’s office.

The governor said that he respected home care workers and collective bargaining rights in general. “We will try to do all we can,” he said.

Budget Woes Cited

Kitzhaber’s bargaining team says that the cuts to home care workers’ benefits are necessary to help close a $300 million budget gap.

Oregon’s in-home care program has been the target of cuts before. On Jan. 1, home care workers saw their hours reduced by 5 percent, a move that saved the state $4 million.

But the SEIU and AARP Oregon say that the newly proposed benefits cuts go too far. The organizations have launched a media campaign asking Oregonians to speak out against the proposed cuts.

“It is extremely disappointing that Gov. Kitzhaber and his team are attempting to reduce benefits for low-wage workers just to save the state a few million dollars,” said PHI Government Affairs Director Carol Regan.

“Beyond that, this is bad fiscal policy,” Regan added. “Reducing low-wage workers’ access to health care will result in higher Medicaid enrollment and put a greater strain on emergency medical care in Oregon. These cuts will simply shift costs, not lower them.”

– by Matthew Ozga

A December ruling by the Ninth U.S. Circuit Court of Appeals could prevent massive cuts to California’s In-Home Supportive Services (IHSS) program.

The Dec. 16 decision (pdf) by the San Francisco-based U.S. Court of Appeals did not directly address California. Rather, it centered on 12 Washington State Medicaid consumers who sued the state for its decision last February to reduce in-home care hours by 10 percent.

The Ninth Circuit found that the dozen plaintiffs would likely be forced to live in nursing homes as a result of the 10 percent cut — a violation of the federal Americans with Disabilities Act (ADA). The court therefore restored in-home services for the plaintiffs.

The court did not overturn the 10 percent cut, however, since the lawsuit was not presented as a class action on behalf of all 45,000 Washington State in-home care recipients.

Implications for California

The Ninth Circuit’s decision has clear implications for another case involving cuts to the California IHSS program.

On Jan. 19, U.S. District Court Judge Claudia Wilken will preside over a hearing to determine whether the state of California can legally proceed with a proposed 20 percent cut to IHSS, which provides care to 440,000 low-income elders and people with disabilities.

In December, Wilken halted the proposed cuts — which had been scheduled to take effect Jan. 1 — because they potentially violated the ADA and the Social Security Act, among other federal laws.

Wilken will have to take the Ninth Circuit’s recent decision into account during the upcoming hearing.

“The Ninth Circuit’s conclusion that loss of hours of home care services exacerbates people’s risk of involuntary institutionalization is very relevant to the case in California,” attorney Stacey Leyton told the San Francisco Chronicle in December.

– by Matthew Ozga