On November 30th the Department of Elderly Affairs held a hearing to propose and increase in the home and community care co-pay programs for home care and adult day care and make eligibility for the programs harder. The Senior Agenda Coalition and 17 advocates from the community opposed the changes because share the concern that the budget deficit projections are too high, based on last quarter’s spending data, and the increase to frail elders is too drastic.
The burden for frail elders for cost-sharing with the state for their long-term care needs will be too great, putting them at a higher risk for entering a nursing home under Medicaid at a far greater expense to taxpayers. The decrease income eligibility will cut elders off the program.
The proposal will require those who qualify for home care and adult day services through the “Co-pay” program to pay increased co-pays ranging from 27 percent to 50 percent. Last year 362 seniors were on the co-pay program for adult daycare and 969 people on the subsidized program for home care.
The cut in help would strike hardest those who earn between $10,210 and $19,341, just over the amount that would qualify them to receive Medicaid for such services — and who cannot live independently without help.
The proposal will also take away the opportunity for people who make slightly over the income limit to still qualify if they have high care costs.
The increases in co-pay and decrease in eligibility seem far too severe for a population that is so vulnerable.
Effect on clients: An older person who is receiving the maximum of 20 hours of home-care service a week is already contributing $5,550 a year to pay for their care. This proposal, a 36-percent increase, will require this person to contribute an additional $2,000 a year to maintain their same level of care.
Personal Story: Claire Couture attends Alternative Care in Woonsocket and would be hurt by this increase. Claire attends adult day 5 days a week, has home care 15 hours a week, and uses RIDE for transportation to adult day. She has moderate Alzheimer's disease and cannot be left alone. The daughter has adjusted her work schedule so she is able to care for her mom. With all the increases in client co-payment that would leave only $400 month for transportation, medications, food, and clothing. This is not enough money to keep her independent in the community.
1. It is too early to implement an increase in the client’s share with risk of their being a budget surplus. Historically, surpluses have reverted back into the general revenue and not into the program that the frail elder needs. The Department should continue to track the budget monthly and analyze if the increase is necessary in the following quarter.
2. Currently it costs the state $13.00 per hour for Co-pay home care ($18.50 less the $5.50 that the client pays). This program currently has a higher income eligibility limit than Medicaid and uses state only funds to pay for care.
However, the Medicaid match is an approximate 50-50 split between the state and the federal government. If some of the clients were paid for through Medicaid, the costs to the state would be only $9.25 per hour for the same service.
The state should look at ways to expand Medicaid eligibility for people where it makes since to take advantage of a match from the federal government.
3. If a budget deficit is in sight, request a smaller increase (less than a dollar) from Co-pay clients (much less than the $5.50/hour to $7.50/hour for some clients) and fund the remaining deficit in the supplemental budget.
Update:
Following this hearing, a Department of Elderly Affairs spokesperson announced at the Long Term Care Coordinating Council meeting that they will continue to allow for the opportunity for folks with slightly higher incomes and high care costs to still qualify for help. As of this date, letters have gone to Governor Carcieri opposing the increases, however we have seen no change in the co-pay increase amounts.
Please contact me with any questions or information at senioragendari@yahoo.com or (401) 274-6900.