by Charles F. Robinson
by Charles F. Robinson
State economists presented an overview of
The House Health and Appropriations Committee begins their 2010-2011 budget process with the instruction to prioritize up to 13 programs/services/funding issues as “top priorities” and the total for these 13 programs cannot exceed a cap of $3.9 billion, which is 85% of the committee’s base budget state funds). Ten or less programs/services/funding issues must then be designated “lowest priorities” and equal 15% of their budget. The long list of department programs includes Departments of Elder Affairs, Health, Children and Families, AHCA, Veterans Affairs, and Persons with Disabilities.
The Senate Health and Human Services Appropriations Committee is anticipating a significant cut in its spending for the 2010-2011 budget. Both the Florida Health Care Association and the Florida Association of Home and Services for the Aging are urging support for home health care programs to divert seniors from nursing home care, for the cost savings they provide. Many clients I represent would prefer to remain in their own home if the cost of appropriate care could be covered, so funding of home based assistance programs is critical. Even if funded, the program is seriously flawed. The Diversion Program is a managed care program for people eligible for nursing care. Diversion recipients can receive services at home or assisted living facilities as well as nursing homes. For persons living in assisted living facilities, Diversion providers contract with the assisted living facility to provide the care component at the facility. The typical care contract pays the facility around $1,200 per month. The room and board component is paid by the recipient. Therein lies the major flaw in the program.
Currently there is no regulation determining how to calculate room and board. Many facilities therefore, subtract the amount of the care component from their private pay rate and allocate that amount to room and board. If the individual’s retirement income is insufficient to pay the room and board amount, the family is called upon to make up the difference. More often than not, the family can’t afford to make up the shortfall and the person must leave the Diversion Program.
It is paradoxical that we allow a “silk stocking” Medicaid program to exist.
The Florida Association of Health Plans (FAHP) proposed to place all Medicaid recipients into managed care. They believe millions of dollars can be saved by moving all programs and clients under managed care because the fee for services programs are costly, inefficient and difficult to administer, and subject to fraud.. These are the same companies touting and participating in the Diversion Program. Replacing choice of programs with managed care will have devastating effects on
It is critically important for all seniors, their families, and their advocates to stay informed about the issues and to stay in touch with elected officials to provide for senior needs in a fair and cost effective way.