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Who Cares About Frail Elders?

The Arkansas Department of Human Services (DHHS) needs nearly $100 million in additional funding in the next fiscal year, and $176 million in the following year, just to maintain current services. Most of the funds are needed for Medicaid, which is experiencing rapid growth in expenditures due to medical inflation, skyrocketing prescription drug prices, growing enrollment and court-ordered rate increases.

Last fall, Governor Huckabee proposed increasing the state's sales tax by 5/8 of a cent to provide funding for Medicaid and other urgent needs, but legislators have failed to support that plan. Some legislators have indicated their intention to wait until fall to pass any tax increases, so they can address education funding along with other funding needs.

DHHS officials warn they cannot wait until fall and will be forced to make huge cuts on July 1, unless additional revenue is provided. The proposed cuts will be much larger than last year's Medicaid cuts, which provoked major citizen protests.

Medicaid services facing cuts
In February, DHHS presented the Joint Budget Committee of the General Assembly with a list of possible targets for budget cuts (see list below). In order to cover a projected $100 million budget shortfall, DHHS would be forced to eliminate entire Medicaid programs, such as Level 3 nursing home care or the ElderChoices home and community care program.
For each dollar of state Medicaid funding cut, Arkansas will lose $3 of federal Medicaid matching funds, so a cut of $100 million from Medicaid will force cuts totaling $400 million in services.

Other cuts by DHHS
DHHS will also be forced to make cuts in staff, facilities and non-Medicaid services, according to DHHS Director Kurt Knickrehm. Other possible cuts include closing some county DHHS offices, laying off some DHHS workers, closing units of the Arkansas State Hospital and one or more Human Development Centers, and reducing funding to community providers, such as the Area Agencies on Aging, Mental Health Centers and Developmental Disability providers.

The Area Agencies on Aging expect that one of the non-Medicaid cuts will be the State Older Workers program, saving about $1.13 million in state funds.

Nursing Home Cuts Likely
Advocates fear that DHHS will be forced to eliminate Medicaid coverage of Level 3 nursing home care. While Level 3 is the lowest level of care covered by Medicaid, these residents require assistance to perform basic activities---eating, using the toilet and walking. Some have physical impairments, while others have dementia and cannot be left alone.

"We depend on Medicaid to cover most of mother's nursing home bill, because her Social Security check is only about $800 a month," says the daughter of a nursing home resident. Her mother is 87, has dementia and can no longer walk due to a stroke. "Without Medicaid, we would have to raise more than $2,200 a month for the nursing home, plus pay for her prescriptions. That scares me to death. Where would we get that kind of money? Each of my brothers and sisters would have to give $300 a month, every month, to make up the difference. We all work, but none of us have high paying jobs. Some are still putting kids through college. Others are almost retirement age. Medicaid has literally been our salvation and our only option," she said.

Nancy Allison, president of Arkansas Advocates for Nursing Home Residents, is worried about what will happen when Level 3 is eliminated. "In one nursing home I visited, only two of the Level 3 residents have families that might be able to help them should they have to leave the nursing home. The nursing home administrator told me that none of the other Level 3 residents are visited by any family.

In order to save $100 million, DHHS is expected to eliminate entire programs:
Medicaid Service	State Funds (in millions)	Persons Affected
Prescription drugs for adults	$ 54.6	105,813
Level 3 Nursing Home	42.6	8,608
Personal care for adults	9.5	——
ElderChoices home and community care	9.0	8,102
IndependentChoices consumer-directed personal care	1.5	1,582
Alternatives home and community care	2.6	1,000
Developmental disabilities home and community care	20.4	3,500
Medically Needy program	19.6	26,226
Vision care for adults	0.5	——
Intermediate Care Facilities, including Human Development Centers and other ICF-MRs	33.3	1,797
Day treatment for developmentally disabled adults	5.7	2,976
Outpatient rehab for the severly mentally ill (RSPMI)	17.3	16,242
Inpatient psychiatric care for persons under 21	27.0	4,898
Private duty nursing for adults	0.5	40
Family planning waiver	1.6	73,891

ElderChoices Devastated
If Medicaid Level 3 nursing home services are eliminated, thousands of ElderChoices participants will also lose Medicaid, because their eligibility is based on nursing home criteria. DHHS estimates that half of ElderChoices patients are Level 3, or about 4,500 people. Some are poor enough to keep their Medicaid cards and continue receiving prescription drugs and personal care, but most will lose all Medicaid services.

"We're not talking about maid service for frail, old ladies," said one advocate. "We're talking about care for people who would otherwise be in nursing homes. They don't just need someone to make the bed; they need someone to lift them out of bed, to get them to the toilet or to feed them. Others have dementia and simply can't be left alone. Their family provides most of their care, but they can't do everything. ElderChoices provides respite care that gives the caregivers a break and helps them keep going. It saves the state money and it saves the families from collapsing."

Older Workers Face Lay-offs
Advocates expect elimination of the State Older Worker program, which provides part-time employment and job training for 142 people 55 and older. Many depend on their paychecks to pay for prescription drugs and other basic needs. In addition, most (93%) are employed in community service jobs in senior centers and adult day care centers.

Diane Harry, president of SPARK (Senior Providers of Arkansas) warns, "Thousands of frail, homebound elders who rely on services provided by State Older Workers may find themselves without Meals on Wheels or Adult Day Care services. Continued cuts to services for homebound, elderly Arkansans threatens to dramatically affect quality of life. It is well documented that assisting folks in staying in their own homes is considerably less expensive to the taxpayer than institutional placement. This is a classic case of throwing the baby out with the bath water."

Mr. Holladay is the Public Affairs Officer for CareLink.