Medicaid changes could hurt homes that cater to Alzheimer's patients

Alzheimer’s support at center of dispute

lbommer@newsobserver.comDecember 13, 2012 

Alzheimer’s patients on Medicaid who are living in special housing may soon have federal payments cut below the limit where businesses can afford to care for them.

New rules on Medicaid limit hours for people who need help bathing, moving, eating and dressing to 80 hours of paid-care per month. The state learned this week that the federal government would not allow people with Alzheimer’s or other forms of dementia who receive Medicaid to get more money under rules that kick in Jan. 1.

Owners of adult care homes say that they won’t be able to afford to keep Alzheimer’s patients on special care units when their Medicaid income is cut by 30 percent or more.

“We’re left hanging as the end of the year comes,” said Tom Husvar, owner of Wake Assisted Living in Raleigh. “It’s got us down to the wire and our backs against the wall, and that shouldn’t have to be.”

Nearly 2,900 people receive personal care services in special care units, and they require more hands-on help than many other adult-care residents. Special care units for Alzheimer’s patients must have one staff person for every eight residents, said Janet Schanzenbach, executive director of the N.C. Association (of) Long-Term Care Facilities, while adult care homes need only one staffer for every 20 patients.

Adult care home owners who care for Alzheimer’s patients are pressuring the legislature to come up with a solution before the year ends.

“This crisis is a direct result of legislative inaction,” Lou Wilson, lobbyist for the Long Term-Care Facilities association, said in a letter to supporters. “These people who suffer from Alzheimer’s and their families need emergency action by the legislature now.”

The group was disappointed that a Blue Ribbon Commission subcommittee examining Medicaid and adult care homes did not come up with a solution at its meeting this week. The association is pressuring the commission for action, and is asking family members of people with Alzheimer’s to write legislators demanding immediate funding.

Legislators say they want to come up with a plan to pay for care in Alzheimer’s units, but they don’t yet know what they will recommend.

“We care about it,” said Sen. Stan Bingham, a subcommittee co-chairman and a Denton Republican. “We’re not going to put our hands up and go hide.”

The legislature required the state Department of Health and Human Services to seek permission from the federal government to give special care unit patients more Medicaid money. Medicaid is a state and federal health insurance program for low-income and elderly residents. The federal government must approve program changes.

The federal government for years pushed the state to rewrite its rules for personal care service payments. Under the old system people receiving the service in their homes had to be more frail that people living in institutions, which violated federal rules on treating people the same, no matter where they live. In its letter this year denying extra money for special care units, the federal Medicaid administrator said the state request for leeway for special care units fell short and did not show how people living at home could also benefit.

Wake Assisted Living is a stand-alone special care center with 60 patients, 40 of them on Medicaid. Husvar, the owner, shows off upgraded shower rooms and a living hall under renovation saying he wants to make improvements for residents in a business that has slim profit margins. The new Medicaid rules have him scrambling to figure out how long he can keep the Wake operation going on $40,000 less per month.

The legislature set aside nearly $40 million in its budget for adult care homes whose residents will lose Medicaid support. Rep. Nelson Dollar, a co-chairman of the Blue Ribbon Commission subcommittee, said the special care units will be eligible for that state rescue money, but he did not know whether they will be able to use it to compensate for all the federal funds they’ll lose starting Jan. 1.

The commission is looking at long-term solutions, he said, while Medicaid for special care units is a short-term problem.

Legislators will work with DHHS officials on another plan to pay for Alzheimer’s care, Dollar said.

“They do a very good job throughout the state with managing and providing a really good environment for individuals suffering from Alzheimer’s,” Dollar said. “We certainly want to ensure that we keep these units adequately supported.”

Bonner: 919-829-4821

News & Observer is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere in the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from profanity, hate speech, personal comments and remarks that are off point. Thank you for taking the time to offer your thoughts.

Commenting FAQs | Terms of Service