• Medicaid Medicaid Every once in a while, an idea comes along that promises to both improve patient care and save money. Managed care was one of those ideas. So was deinstitutionalization – emptying psychiatric hospitals so patients could get
• Medicaid
Medicaid
Every once in a while, an idea comes along that promises to both improve patient care and save money. Managed care was one of those ideas. So was deinstitutionalization – emptying psychiatric hospitals so patients could get less expensive care and live more fulfilling lives, in the community.
More recently, the trend has been toward what’s called home-based care. Think of it as deinstitutionalization for elderly and disabled nursing home residents. Those enrolled in Medicaid, the federal health insurance program for the poor, get treatment as well as help with bathing and cooking. Best of all, they get to stay in their own houses instead of moving into a nursing home, where care is much more expensive.
Beginning about 10 years ago, federal officials started signing off on Medicaid home care programs in state after state, including Missouri and Illinois. The pace of approvals for such home care programs, which are called waivers, has increased dramatically under the administration of President George W. Bush. Whenever states have sought waivers, the Bush administration has asked for a cap on how much money it would provide to that state’s Medicaid program. Traditionally, the state and federal governments split Medicaid costs. The insistence on caps makes it seem that the Bush administration is more interested in saving money than guaranteeing care for Medicaid patients.
In theory, it could accomplish both goals with home-based care. But as a recently released report from the General Accounting Office points out, things haven’t necessarily worked out as planned. Once they approved the home care programs, federal officials have done little or no follow up to make sure they were operating as promised. They’ve also renewed programs in states like Missouri without checking to make sure patients are getting the same quality care as that delivered in nursing homes. That’s contrary to federal law, the GAO said.
Nor has the federal government spelled out for the states what they should be doing to check up on the quality of home care, such as reviewing medical records and interviewing patients and care providers. Because there are no standards for states, and little oversight by the federal government, there is often no one making sure home care programs are living up to their obligations.
In many cases, unfortunately, they aren’t. When congressional investigators looked at a sample of 51 home care programs across the country, they found patients weren’t getting all the services their doctors called for, such as physical therapy, or help with taking medications.
Federal and state taxpayers are spending billions every year on home care for hundreds of thousands of elderly and disabled people eligible for Medicaid programs. But that money will be ill-spent – and those patients imperiled – unless federal officials take the time to set quality assurance standards and hold states accountable for meeting them.
Setting standards doesn’t require new legislation; they can be set by the Centers for Medicare and Medicaid Services. Tom Scully, who heads the center, or Tommy Thompson, the secretary of health and human services, are the logical ones to address this problem. But if they don’t act soon, Congress must step in and do so.
St. Louis Post-Dispatch
