care. And the Florida legislature, grappling with deficits
of more than $2.8 billion for 2009, lopped almost $2 million from the state’s Community Care for the Elderly
program—which supplies home care, meals, adult day
care and a host of other services—before Republican
Gov. Charlie Crist vetoed the cut.
Such reductions around the nation could undo progress
in shifting funding for long-term care away from nursing
homes and into services that give people more choices
for where to live. Some of these home services are fully
funded by the states; others are part of Medicaid, the joint
state and federal health care and long-term care program
for low-income Americans. On average more than 21 percent of all state spending goes to Medicaid, which makes
its programs a tempting target for budget cutters.
By law, state Medicaid programs are required to pay
for nursing home care for those who qualify for help
with long-term care, and the majority of long-term care
dollars go to these facilities. But the federal government
also gives states the option to develop services that help
people who qualify for long-term care to remain in their
own homes—a choice nine of 10 older Americans prefer
over nursing homes, according to AARP research. From
1995 to 2007, total Medicaid spending on such services
more than doubled to 41 percent, according to the Kaiser Commission on Medicaid and the Uninsured. These
programs now serve some 2. 8 million Americans.
educing these services, experts say, is a false
economy because it forces people into nursing
homes, which cost the state more. Florida’s
Community Care for the Elderly, for example,
“Home care, meals, help for Alzheimer’s caregivers—all help the
state save money by keeping people out of nursing homes, and that’s
a message we want to take to legislators,” says Randy Hunt, CEO
of the Senior Resource Alliance, an area office on aging in Orlando.
Hunt knows that lawmakers now working on Florida’s 2010 budget
are staring at an estimated shortfall of $5 billion.
In the coming months, states will be looking for sources of new revenue—higher taxes on cigarettes, sales taxes on the Internet, increased
traffic fines—and trying to find the least harmful cuts they can make.
Reluctant to chop a whole program or service, lawmakers may freeze
or cut fees to those who provide the services, including not only nursing
homes and hospitals, but also agencies that supply home care workers
and health aides. Such cuts, though, eventually tend to translate into
problems of access and quality of care, says Nick Johnson, director of
the state fiscal project for the CBPP.
Unfortunately, even the economic stimulus package assembled by
Congress and President Obama—with its billions of dollars of state
aid, including more than $87 billion for state aging and Medicaid pro-
grams—does not fully protect these home and community long-term
care services. “The stimulus money will give states a baseline, so cuts
may not have to be so drastic,” says Donna Folkemer, group director
for health at the NCSL. “But it probably won’t allow new programs
or even help them to hold on to all the current programs.”
And standing still can be moving backwards. Consider Florida.
While its Community Care for the Elderly escaped cuts this year,
for nine years it has gone without a budget increase while its target
population of older residents has grown by 700,000, according to
Jack McRay, advocacy manager at the AARP Florida state office in
Tallahassee. Today, 50,000 older Floridians are on waiting lists for
these kinds of home services, state experts say, and 2,272 people died
last year while on lists.
Those numbers worry Shirley Miller, who, up until she was 80,
earned extra money by working the night shift at the reception desk
of her apartment building. “When you’ve been independent all your
life, you don’t want to ask for help,” Miller says. “But I just can’t keep
up anymore. I need help.” ;