PCO plan in cross hairs

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PCO plan in cross hairs

Officials flinch as cost of program for disabled, elderly skyrockets

By Dan Shingler, the Tribune

New Mexico 's Private Care Option program has grown its way into trouble - and a painful diet may be on the way for some of the 9,000 state residents who rely on the program.

Founded in 1999 as a way to help the state save money by keeping Medicaid recipients out of nursing homes and allowing them to pay for their own in-home care, the program has far exceeded all expectations - and fears.

The program was supposed to cost $10 million a year, but this year alone it will run a $70 million price tag for the state.

That's too much, said Sen. Sue Wilson Beffort, an Albuquerque Republican and a member of the Legislative Health and Human Services Committee that oversees the PCO and other Medicaid programs.

"In the best world, we'd love to help everybody. But realistically these programs were set up to help our most frail, our most needy and, in the case of Medicaid, our most poor. You just can't give everything to everyone," Beffort said.

Beffort said the PCO program has cast too broad a net and is aiding far more people than just the elderly, who would otherwise be in more expensive nursing homes.

"I think it was too broad, and people took advantage of it," Beffort said.

Participants in the program usually employ family members to provide their care. Beffort suggested family members should generally care for each other without being paid to do so by the state.

She also said PCO provider agencies around the state, many of them for-profit entities, had promoted the program too aggressively because they make money off of every participant they enroll.

Advocates for the elderly, however, say that the program has grown more than anticipated because the need for it was far greater than legislators realized.

"The growth in this program is about incredible need in New Mexico and not wanting family members to be institutionalized," said Beverly Bien, executive director of Los Lunas-based La Vida Felicidad social services agency.

"Essentially, a lot of these people would go without services without this program," Bien said.

The controversy is not likely to go away soon. The state predicts the program will only slow its growth over the next 18 months.

But Beffort said that unless state Medicaid officials find a way to narrow the focus of the program to the state's most needy elderly, and soon, the Legislature will likely act to curtail the program.