Publicly sponsored programs aimed at keeping people who might otherwise be in institutions at home are valuable indeed. To the individuals, of course, but also to society. Those with needs who retain a measure of personal freedom feel better about themselves and are able to live independently. When such services are provided by Medicaid, the federal/state health insurance program for the poor and disabled, that self-reliance also saves money over providing institutional care.
But a dispute is afoot, as reported by The News & Observer's Thomas Goldsmith.
On one hand, some legislators are worried that the program, which falls under the heading of "in-home services" (or personal services), is going way over budget, and part of the reason may be that too many people are qualifying for it.
The services include helping people with bathing, going to the toilet, eating, dressing and getting about. Clients are people of all ages coping with chronic disabilities. And the fact that someone will be in a person's home regularly, even for a brief time, ensures that a person who lives alone will at least have someone checking on them. So many disabled people live in sad and lonely circumstances and are at constant risk of falling and other mishaps.
OK, so all this said, there's some practicality that has to be considered.
The funding that goes to Medicaid for these types of services is limited (the budget for this year, after legislative cuts reflecting the financial crisis, is already way over the set amount) and must be targeted strictly to those who qualify. That means doctors must take a close interest, patients must be realistic about what they can do and what they cannot do, families must be fair in terms of recognizing that there are some services they can provide - freeing up money for helping people who have no one else.
Then there are the companies that provide the services under contract. Some legislators have questioned whether too many people are qualifying because doctors are not reviewing cases closely enough, going on recommendations from the very companies that have a financial interest in seeing that people qualify.
Jennifer Weiss, a Cary Democrat and one of the state House members most closely attuned to this and other health-care issues, described the problem as "incredibly frustrating and disturbing," and remember, this is someone who spends a lot of time on Jones Street.
Weiss boiled the issue down well: "An explosion of misauthorization and misuse has got to stop. But at the same time, when we are turning off the tap, we need to make sure that people that need care get it."
People who qualify for services are supposed to need help with at least two important daily activities, such as eating or bathing. But one study of the program cited by Medicaid said that perhaps 40 percent of the people getting help didn't really qualify for even the most basic of services. And the number of people receiving the services rose 146 percent in seven years, between 2002 and 2009, from more than 15,000 people to more than 38,000.
New legislation requiring stricter oversight of whether clients really need help should eliminate some waste of money, which is important to save the services for those who really need them. Thankfully, officials at all levels promise that no one who really needs help will be turned away.
