Banishing the disabled - Wisconsin caps home-care reimbursement

Progressive, The, March, 1996 by Ruth Conniff

According to a letter sent to home-care providers by the Department of Health and Social Services, the "small percentage of people having to enter nursing homes" because of the state's home-care cap, will be "free to leave the nursing home for work, education, and social events."

But disabled people and their advocates are extremely skeptical. Many have heard horror stories about nursing homes.

"Some people are terrified because they've been in nursing homes and they have not done well," says Froemming. "They've had recurrent respiratory infections, bedsores, or they've been left without bathing for a week."

Even a relatively pleasant place like City View, with a friendly, empathetic staff, is not geared toward helping people lead active lives outside the institution. "We've never had someone here who's going to school and working," says Griffin. "I wouldn't say it's impossible. But the leeway and flexibility they're used to having wouldn't be there."

The price of freedom for some people with disabilities is just too high, the state legislature has decided. It's time to set priorities.

According to Angela Dombrowicki, chief of the policy section of the Bureau of Health Care Financing, the cap on home care "puts some kind of rationality in the system and sets some limits. With home-care services, there really are no incentives to limit spending on care. This is a first step toward a more managed system."

Medicaid rolls are indeed expanding at record rates. Over the next five years, Medicaid enrollment across the nation is expected to rise by 21 percent. Legislators are proposing caps, managed care, and other efforts to deal with the growing expense. Meanwhile, record numbers of people are still uninsured. There's no question that there's a health-care crisis.

"We need to get health costs under control, and we need to look at quality," says Edith Rasell, an economist at the Economic Policy Institute in Washington, D.C. "But you're not going to fix the problems with the health-care system by attacking Medicare and Medicaid. We need a comprehensive health-care solution, and nobody is even talking about that."

In the end, Wisconsin isn't going to save very much money with the home-care cap. For each of the next two fiscal years, the Bureau of Health Care Financing projects it will save $5,686,500 out of a total annual Medicaid budget of $2.4 billion, or about 0.2 percent--not much, considering the agony of the people affected.

Still, there is the question of priorities. Although up to now Medicaid has been "an open-ended entitlement" by the state's definition, there is not enough home care to go around. Because of a shortage of personal-care workers, the Medicaid personal-care program can't serve everyone who wants help. Medicaid also doesn't cover services like laundry and grocery shopping that the elderly and disabled need in order to live in the community. So, in 1982, the state created the Community Options Program for people at risk of going into nursing homes. Community Options pays for some things that Medical Assistance doesn't cover. But, unlike Medicaid, it is not an entitlement program. It only serves a fraction of the people who apply. According to the state, capping care for the most expensive clients will free up slots for people with less expensive needs.