Editor’s note: In the hard copy version of the Senior Scene and the online version, we ran an article from Ingrid McDonald, Washington’s Advocacy Director for AARP.  This is a follow up with additional information about the effect of the proposed cuts and AARP’s response and suggestions.

Urgent Advisory: The 2011 Special Session and Risk of Deep Cuts to Long Term Care Services

To address a $1.4 billion budget deficit, the Governor has asked state agencies to submit proposals for reducing spending by in the 2011-13 biennium.  These proposals will form the framework for a budget proposal that state lawmakers will consider in a Special Session beginning November 28^th 2011.

Current proposals would completely eliminate long term care services for more than 17,000 people, a 29% cut from current levels. This proposal turns the clock backwards on decades of progress towards providing client centered long term care services, consumer choice and cost containment through rebalancing.  A recent AARP report rated Washington’s long term care system 2^nd best in the nation. That status is now clearly at risk.

The mechanism for this proposed cut is a change in the functional ability eligibility requirement for Medicaid funded long term care services. According to the proposal, only people who require extensive assistance with most daily activities and are medically complex, including people with major cognitive issues, will retain services.  Beneficiaries who need intermittent assistance, or who need supervision rather than hands-on assistance, will no longer be eligible.

Services would be eliminated for the following people:

• 11,700 people will lose homecare assistance
• 1,000 people who live in Adult Family Homes
• 2,700 people living in assisted living facilities
• 1,000 people living in boarding homes
•  450 people living in nursing homes

In addition to these cuts, 1,000 people would be impacted by the elimination of Adult Day Health.  By definition, with very few exceptions, the people who qualify for these Medicaid funded services have less than $2,000 in assets and less than $2,022 per month in income. They already contribute on a sliding scale to their own care. They cannot afford to cover the full cost of their care on their own. Where will they go and what will they do?

What will happen if Washington asks vulnerable adults to fend for themselves?

•  Family caregivers will not be able to pick up the slack. Many long term care clients have no family or have only long distance support.  A recent AARP report found that the average caregiver is a 49 year old woman who is still working and who also spends 20 hours per week providing unpaid care to her mother for nearly five years.

• There will be more calls to law enforcement, 911 and Adult Protective Services. People who can sometimes get out of bed but not always or who can’t walk up and down the stairs in front of their house or who can’t cook – are not safe in their own homes and are at risk of injury and self neglect. Without supportive housing or home care help many will find themselves in crisis, and when friends or neighbors notice they will respond by calling  911 or APS.
• People will decline faster and utilize more expensive health care services. Without appropriate support, the health status of this population will decline. Washington will see an increase in expensive emergency room visits and hospitalizations and more people qualifying more quickly for higher levels of care.
• Thousands of caregivers will lose jobs. For every person who loses home care assistance, a home care worker loses income and in the event that was their only client, loses their job. With fewer paying residents, some long term care facilities will lay off their employees or shut their doors. In this recession, keeping people employed must be a top priority.

What is the alternative? Raise revenue.

AARP agrees with the many organizations urging the legislature to send a referendum to the people so the citizens of our state can decide whether they want to close tax loopholes or otherwise raise revenue to avoid painful cuts.  In addition, we are urging the legislature to fully explore all possible options to offset long term care cuts by maximizing federal funds or raising fees – here are some examples:

•  Community First Choice (CFC) – Washington State is eligible to receive a 6 percent increase in the federal matching percentage (FMAP) for home care services that is available through Section 2401 of the federal Patient Protection and Affordable Care Act. The Department of Social and Health Services included CFC in their budget proposal to the Governor but due to federal rules they will not be able to pursue this option if the functional ability cut is enacted. Washington should aggressively pursue this option which could generate tens of millions of dollars in new revenue.

•  Adult Family Home License Fee – Adult Family Homes should pay for the full cost of their oversight as all other long term care providers do. Last year the legislature moved in this direction by increasing the license fee from $100 per home to $100 per bed in FY 2012 and $175 per bed in FY 2013 plus initial fee of $2,700. The legislature should accelerate this increase so that these providers are fully funding their own oversight and savings can be used to mitigate cuts.

•  Maximize Safety Net Assessments – Last year the legislature passed a nursing home safety net assessment. To mitigate cuts, the legislature should consider upping this assessment to the federal maximum and look at what other providers, including home and community based long term care providers, could be similarly assessed.

What You Can Do

 1)      E-mail the Governor to express your concern

Click here or paste this into your browser: http://www.governor.wa.gov/contact/default.asp

 2)      Call your state lawmaker

Call the Toll Free Legislative Hotline:1-800-562-6000

 3)      Share your story

Help us share the people behind the numbers, e-mail your story to aarpwa@aarp.org