Of all the budget cuts state lawmakers have made to the Medicaid-sponsored programs, one offering has been protected and may get even more dollars.
State funding for the MI Choice Medicaid Waiver Program has been sustained over the past few years, and Gov. Jennifer Granholm has increased funding for it in the executive budget she unveiled in February.
Still, a new problem has developed because of the way the funds have been assigned.
The waiver program, which began in 1992, is part of the long-term care budget, and it provides in-home services to seniors and certified disabled individuals between the ages of 18 and 64 who are at risk of being placed in a nursing home or want to leave one and return to their homes. Medicaid funds are used to create a care management team and pay for a variety of basic services.
A team, which is made up of a social worker and a registered nurse, develops a care plan for each individual that can include up to 13 different services, including homemaking, transportation, meals, counseling and private duty nursing.
“Because we’ve been helping people transition out of nursing facilities, I think that the state has been looking at the waiver program as a program that can kind of help rebalance the long-term care system,” said Suzanne Filby-Clark, program director for the Area Agency on Aging of West Michigan, which administers the program across a nine-county region.
“So they’ve really been kind of holding us harmless and actually giving us a little bit more money for the waiver program to continue it,” she said.
The reason, of course, is to control the Medicaid budget: Keeping people out of nursing homes is less costly than covering their stays.
Filby-Clark said the agency receives about $10 million a year from the Department of Community Health’s Medicaid budget to administer the program.
“We use a provider pool with purchase-of-service agreements to cover all the different services we can provide, and we have roughly about 80 providers in that pool to cover a nine-county area,” she said.
About half of the program’s clients live in Kent County, which is a representative figure of the total population AAAWM serves across the nine counties. The number of current clients in the waiver program is lower than in past years.
“This year there is something new with our program where we can also serve people in licensed settings, like licensed homes for the aged or adult foster care. So that’s another option for people who are either in the community and are becoming a little too frail to live on their own,” she said.
Filby-Clark, who has been at AAAWM for 24 years, said clients have to meet specific criteria regarding income and assets to qualify for the waiver program. Monthly income can’t exceed $2,022 a month, while liquid assets must be under $2,000. Those figures have been established by the state and are the same for those who enter a nursing facility.
Like a Medicaid-funded nursing home application, only individual income is counted for the waiver program. Household income is exempted. Spousal protection for income and assets is also part of the waiver. But the waiver program has one key regulation that differs from the Medicaid rules that cover a nursing home.
“There is no spend-down in this program,” said Filby-Clark.
“If you’re familiar with Medicaid in the community, people might have to spend some money because they might be a little over the income amount. They can do that through allowable expenses. But in the waiver program, if someone had $2,022.05, they’d be over the income limit and that would be the end of the story.”
AAAWM helps potential clients with Medicaid applications, which need verifications from multiple sources such as insurance companies, banks and credit unions.
The governor’s 2011 budget contains an increase for the waiver program. But Filby-Clark said the hike is mostly targeted to the portion of the program that transitions people from nursing facilities to their homes or to the other, less costly residences.
So in a sense, the agency has two application lists for the waiver program from the way funds to the program are targeted. One is a very lengthy waiting list for new people living in the community that apply for a nursing facility. Their applications are added to the bottom of the list and are taken in chronological order, as the AAAWM waiver budget allows.
People who want to leave a facility, though, have virtually no wait.
“If you’re in a nursing facility and you’re looking to transition out with waiver services, then that becomes a priority case, and that’s where the state’s funding is aimed. So there is funding available to transition, but the funding has been flat for people on the chronological wait list,” she said.
“That’s kind of getting to be very problematic for us because if you went on the wait list today, you could wait for almost two years for an opening.”
Filby-Clark said she understands what the state is trying to do with the budget being such a contentious issue. She also knows that finding less expensive options for long-term care is a major priority in order to ease some of the tensions surrounding the state’s spending plan.
“But I think from our perspective, the biggest thing is providing that array of choice for people. So if someone needs long-term care services, it’s best that they have that option of having a facility there to help,” said Filby-Clark
Governor offers DCH a bigger budget
In the executive budget she presented last month, Gov. Jennifer Granholm said Medicaid would account for 91 percent of the Department of Community Health’s spending plan for the coming fiscal year.
The governor reported her budget offers $526.3 million for community-based long-term care services, such as the MI Choice Medicaid Waiver Program. Granholm said moving the elderly and the disabled from nursing homes to home care would save the state $19.7 million in the 2011 fiscal year, if her budget is adopted.
Overall, her budget has $2.1 billion earmarked for the long-term care portion of the Medicaid program and $7.3 billion for medical services. Taken together, the governor said those figures represent a 14.3 percent increase from the current levels.
In the governor’s budget, general fund revenue to DCH is decreased by 12 percent. Here is a comparative snapshot of this year’s DCH budget and what Granholm has recommended for next year.
Source: Gov. Jennifer Granholm, Executive Budget, February 2010