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Bill would open elderly care options

If passed, bill would allow Medicaid payment for in-home care in all states

Posted: June 2, 2009 10:10 p.m.
Updated: June 3, 2009 4:55 a.m.
Health-care officials are split over the Community Choice Act, a federal bill designed to open up more long-term health-care options for the elderly and disabled. The bill is currently before two separate congressional committees.

If approved, the Community Choice Act would transform current Medicaid policy in many states by allowing elderly patients - once limited by individual state policy to nursing homes - to receive home nursing care at a patient's own home, or in a home belonging to a patient's family member, said Fred Leaf, senior advisor on health policy to Los Angeles County Fifth District Supervisor Michael Antonovich.

California currently pays for in-home care with federal Medicaid funds. If approved, Medicaid funding for in-home care would be available nationwide, and additional matching funds would be available for California's in-home nursing-care program, Leaf added.

"In California, we have in-home support service paid for by Medicaid," Leaf said. "We may or may not have that right in other states."

The Board of Supervisors, on the recommendation of Antonovich, agreed to draft a letter of support for the bill Tuesday. The letter will be sent to Congress by the end of the week, said Tony Bell, Antonovich's spokesman.

While the Board of Supervisors supports the bill, one local senior-care official has concerns about the Community Choice Act.

"The responsibility is now going to fall on extended families," said Brad Berens, executive director for the Santa Clarita Valley Committee on Aging. "This is just another way of shifting the burden from the government and on to families."

Berens' concerns range from the funding of the program, which remains unclear, to the Medicaid eligibility requirements for those receiving extended nursing care.

"Will it be enough to take care of the persons as their needs grow?" he asked.

The bill is in its early stages, and the financial impacts of the legislation on Medicaid benefits are unknown, Leaf said.

Berens said before the bill can be passed into law, Medicaid must change its eligibility requirements. Currently, those Medicaid-eligible seniors who live with family members risk losing those benefits if the family member's income exceeds certain thresholds.

"My fear is that these people will move into the family member's home and then lose their eligibility based on the family member's income," he said.

Even if the Community Choice Act changes the eligibility standards for Medicaid-funded nursing-home care, Berens worries that families could be overwhelmed by taking care of aging relatives.

"We are seeing adult children taking care of their parents while their own children are still in the house," he said. "That can be stressful."
Berens does see some positives in the Community Choice Act's language as it stands.

"The person being cared for is close to family members and is aging in place. There is less likelihood of the patient sinking into a depressive state and hastening their demise," he said.

Berens also said assistance to families who want to provide care for their relatives at home is needed. "The great majority of us can not afford in-home services if we had to pay the costs out-of-pocket," he said.

Leaf said the program also benefits taxpayers who support Medicaid.

Health-care costs are skyrocketing and hospital treatment is costly. Treating the same patient at home is much more cost-effective, Leaf said.

Berens said the average cost to provide home nursing care is about $30,000. "A skilled nursing facility (for critically ill, non-ambulatory patients) is about 10 times that amount," he said.

The bill is before the United State House of Representatives Committee on Energy and Commerce and the United State Senate Committee on Finance. There is no set date on when the bill will go before the Congress for vote.


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