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Elderly,
infirm fear loss of Medicaid benefits By
Deborah Yetter The
Courier-Journal, July 20, 2003
GLASGOW, Ky. — Judy Whitlow, 97, weeps when she talks about being forced out of her nursing home because Medicaid is cutting off her benefits. "I want to stay here," said Whitlow, who has congestive heart failure and an unsteady gait that sometimes causes her to fall. "I don't want to leave." Veda Kerr, 93, who's had her legs amputated and has a heart condition and a digestive disorder, said she can't understand why Medicaid has decided she must leave the Bowling Green nursing home where she's lived for 15 months."It don't seem like it's fair," said Kerr, a widow with no children. "I've got no place to go back to."
And Mary Gerton, a 79-year-old widow who has heart and lung disease, is on oxygen and must use leg braces and a walker to get around her Campbellsville home, said Medicaid has cut off her home assistance and medical benefits. "I don't see how they can treat us old people like that," she said. Since the state began making sweeping changes in April aimed at reducing a projected $450 million Medicaid budget deficit this fiscal year, nearly 1,800 Kentuckians have been denied Medicaid services — based on the presumption they can care for themselves at home. They include 216 people seeking nursing home care and 1,566 seeking assistance in the home or community because of infirmity or disability, according to Medicaid numbers through the end of June. The numbers also cover people using adult day care — including the elderly and mentally disabled — and emotionally disturbed or autistic children receiving therapy under Medicaid.
Most haven't yet lost services because they have a right to appeal and can't be cut off without a hearing , and a growing backlog of appeals may buy some extra time . But advocates said it will be tough for many clients to win an appeal because of the stricter guidelines . Whitlow and Kerr, who have ap pealed, said they have no idea where they'll go if they lose. Gerton, who decided not to appeal, said she doesn't know where she will find help once some temporary assistance funded by Medicare ends. Medicaid officials said they realize some people will be forced from nursing homes and will have to find somewhere else to live, but the budget has left them no choice but to cut services. "It's painful for us to make these decisions," said state Health Services Secretary Marcia Morgan. Drastic cuts required The changes follow the state's decision earlier this year to eliminate a category of Medicaid service considered "personal care" — as opposed to those more seriously ill or disabled and deemed in need of more intensive nursing care. Reviews of Medicaid recipients and those applying for service — including about 17,000 in nursing homes — are ongoing and more people are expected to lose benefits. State officials say that without additional money, they must make drastic cuts in the federal-state health plan that pays for the poor, disabled and elderly in nursing homes. "We have consistently said there would be consequences," Morgan said. "We very much believe we ought to cover those most in need and those most vulnerable, and there are no good choices left." But the cuts are outraging advocates, family members and others who say the changes are shattering lives and leaving some people who can't take care of themselves with no options. "These politicians — whoever's making the rules — they need to know what it's doing to these people," said Yvonne Cook, administrator of the Glenview Health Care Facility in Glasgow , where Whitlow lives. "It just blows my mind that we as a society are kicking them out of their homes." State Rep. Mary Lou Marzian, D-Louisville, agreed and blamed the anti-tax stance of the public and many legislators. "It's easy to say cut the fat and cut the waste," said Marzian, who unsuccessfully pushed a tobacco tax increase this year to help pay for health services . "But these are real people and this is what we're cutting. Unless we do our jobs and increase revenue, it's going to continue." State Rep. Tom Burch, D- Buechel, who is chairman of the House Health and Welfare Committee, said the legislature is to blame for refusing to pass a budget that included new taxes he and others proposed. "Our problem is that we didn't raise any revenue," he said. "We have to bite the bullet." Republicans who control the Senate, however, have steadfastly resisted new taxes.Republican state Sen. Charlie Borders of Russell, the Senate majority caucus chairman, said he's concerned by reports of people losing services. But he said Senate Republicans won't support any tax increases until they're convinced the state is operating efficiently and finding the best solutions for those in need. "I think they're doing their job," he said of Medicaid officials. "There's a lot of things we need to look at before we start talking about tax increases. What we need to talk about are runaway costs." But Republican state Rep. Steve Nunn of Glasgow said he doesn't think talk of cost control will comfort residents forced out of nursing homes. "It's going to be terribly painful for a lot of folks," he said. Uncertain futures Residents who have appealed said they're being forced to live in uncertainty. "It's worried me quite a bit," Kerr said. It's up to family members or others involved in looking after someone to try to find a home for those forced to leave, although most nursing homes try to help. If the person has no friends or family and the nursing home can't help, state social workers would intervene and find somewhere for that person to live. But options for care are limited. Some people could go to cheaper personal care or family care homes, which offer no nursing services and assume residents can look after their own needs. Critics of the cuts say many of those in nursing homes couldn't survive in such settings without nursing care and close supervision, and certainly couldn't manage alone in an apartment or home. Danny Cravens of Smiths Grove said his mother, Madell Cravens, 86 — recently notified she no longer qualifies for Medicaid — has Alzheimer's disease, falls frequently and forgets to eat or take her medicine. He is disabled, can't take her in and doesn't know what to do now that she's about to lose her spot in a Glasgow nursing home. Cravens said he doesn't think she'll be safe in a personal care home where residents get rooms and meals but generally are expected to look after themselves. His mother is devastated, he said. "She knows they're going to put her out," Cravens said. "She was sitting in a chair just bawling her eyes out." State Rep. Jimmie Lee, D-Elizabethtown , chairman of the House human services budget subcommittee, said he realizes the changes are creating hardships. He said lawmakers need to look at whether the state should provide alternatives for people forced out of nursing homes or those who have lost services. "There's got to be more than just saying to them, `You've got to leave, ' " Lee said. "If they leave, where do they go and what kind of care do they get?" Options are limited Many nursing home residents have exhausted their personal resources and turned to Medicaid after spending their savings, said advocates and family members. All continue to contribute whatever income they have — Social Security, disability checks or a pension — to the cost of their care. They include Lillie Atwell, 97, a retired teacher who contributes her $1,170 per month pension and Social Security check to the roughly $3, 7 00 per month cost of her care at the Hart County Health Care Center. She has been cut off the Medicaid program, despite having had two strokes, being nearly blind and deaf and being unable to sit up or get out of bed without assistance. Her son, Bobby Atwell, a farmer, can't believe the state is forcing his mother out of the nursing home after her years of public service in the classroom. "She has influenced more lives in Hart County than I'd care to remember," he said. Lillie Atwell's doctor, Richard Ribeyre of Cave City, said he's incredulous at Medicaid's decision. Ribeyre said he went through Atwell's medical records and documented health problems he thought would guarantee her stay. "The idea that she could care for herself is ludicrous," he said. "It would be like throwing a baby out on the street." Whitlow's only local relative, niece Mary Peden, 73, herself has health problems and said she can't care for the 97-year-old if she's forced out of the Glasgow nursing home. She said Whitlow, who lived at home until she was 91, simply can't care for herself — despite what Medicaid says. Cook, the administrator at Whitlow's nursing home, said the Medicaid reviews have frightened the other 60 residents — most of them on Medicaid — since Whitlow and another woman, retired teacher Christine Mathis, 94, were notified they've been cut from the program. "They're all scared to death that they're going to be the next one," Cook said. Home health nurse Carla Major of Taylor County noted that those losing home or community services also lose all Medicaid benefits, including prescription drug coverage and transportation to the doctor, if they're cut from the program. Gerton, of Campbellsville, who has no children and no local relatives, said she can't afford prescriptions that cost about $250 per month and can't even put on and take off her leg braces without help. "It really upsets me," she said. "It's been pretty rough and it's going to get rougher if they don't make some different rules on this stuff." Appeals may be tough The state, using a contract agency, Health Care Review Corp., is reviewing client files to determine whether it appears some people can care for themselves. If its doctors and nurses decide they can, the clients get a notice that they are being cut off Medicaid for nursing home or home and community services. To qualify, clients must need at least three services every day among the following: assistance with mobility; help with confusion or agitation; feeding; us ing the toilet; medication; injections; physical therapy; communication and dressing; and bathing or grooming. Reviewers rely on records from the facility or company that provides the service — such as a home health agency — and don't necessarily see the individual, Morgan said. A physician's opinion is considered but not required. Rich Seckel, a lawyer with the Kentucky Legal Services Program, the research arm of the state's four regional Legal Aid offices, said all four offices are getting requests for help from people filing appeals. He said staff lawyers have found the review agency overlooked or didn't get important information that in a few cases caused officials to restore Medicaid benefits. But of greater concern to Legal Aid lawyers, he said, is that the new rules for nursing care appear so narrow they will exclude people who clearly need the help. Just the age of some people in their 90s should help them qualify, he said. "If people need care and are not getting it, something's wrong," he said. Even if they appeal, many people currently getting services probably won't fare well — unless they can present significant new information the reviewers didn't consider, advocates said. "I think most of these people are going to lose," said Ruth Morgan, a regional ombudsman for nursing home residents in Southern Kentucky. "The hearing is to determine whether the new criteria was properly applied — not whether the new criteria is appropriate." Meanwhile, the number of appeals is growing. More than 1,000 have been filed this year, and Morgan said Medicaid is seeking additional hearing officers and lawyers to help handle the caseload. Advocates also are upset that the rule changes are being applied retroactively — affecting people who have been in nursing homes or getting services at home for years. "It's very unfair to change the rules on these people after they have done what they were supposed to do," said Cathy Allgood Murphy, a lobbyist for AARP of Kentucky. "It's very cruel." State officials say they have no choice — the federal government, which provides about 70 percent of Kentucky's Medicaid funds, requires that all rule changes for people applying for Medicaid must also apply to those already receiving services. That doesn't comfort nursing home residents — some of whom have been at the same facility for years. Lucille Stasel, 91, who has been at the Hart County Health Care Center for seven years — the past three on Medicaid — can't understand why the state has reversed itself and no longer believes she needs to be in a nursing home. "It's my home," she said. "They're not going to make me move, are they?" Copyright ©
2002 Global Action on Aging
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