Care providers: Medicaid cuts will shift costs

JEFFERSON CITY, Mo. -- A proposed cut to a Missouri Medicaid program providing in-home care to elderly and disabled people too poor to pay for it themselves will end up shifting costs to hospital visits, care providers said.

Gov. Eric Greitens last week proposed cutting $52 million from state general revenue to a home and community based services program that provides services to more than 80,000 people statewide.

The cuts would make it harder to qualify for care, preventing nearly 20,000 people from receiving services.

One such woman is Lorrine Darden -- a 79-year-old mother of nine who has received nursing care in her St. Louis home since she had brain surgery nearly a decade ago.

For Darden, who suffers from seizures, her care provider is a lifeline, she said.

Her primary caretaker, Debra Hollins, washes her dishes, bathes her, cooks meals and cleans her house.

Five days a week for 2 1/2 hours, Hollins makes sure Darden doesn't fall or burn herself on a kitchen stove.

"If it wasn't for (Hollins), I wouldn't be able to have my independence like I do," Darden said.

If Greitens' proposal passes, recipients such as Darden would have to show a greater level of need to qualify for in-home or nursing home care services.

In-home providers say the cut would cost the state more money in the long run because people ultimately will end up in the emergency room without anyone to make meals or monitor medications.

Rep. Scott Fitzpatrick, the chairman of the House budget committee, said it was too early to comment on whether the cuts will make it through the House and Senate.

He said he would have to wait until a Department of Health and Senior Services presentation in committee this week.

Greitens' spokesman Parker Briden and the Department of Health and Senior Services didn't respond to requests for comment.

The general revenue cuts come primarily through a change in a point system determining a person's level of need.

The Missouri Department of Health and Senior Services awards a score based on a person's needs such as number of doctor's visits, complexity of medication, or whether they can drive.

Under the current law, recipients need to score 21 points to be eligible for in-home or nursing-home care. Greitens' proposal would raise it to 27 points.

Carol Hudspeth, executive director of the Missouri Home Care Alliance, said it's hard to pinpoint the difference between a 21 and a 27 because there are so many variables used to determine needed services.

But Kimberly Lemarr, a field coordinator for Oxford HealthCare, said all her clients, regardless of point count, need help.

Without care, some would forget to take their medicine, others would forget to eat, and some would get depressed, Lemarr said.

"They just wouldn't be able to function," she said. "You'd see people lining up in the hospital a lot more."

The cuts also could put people out of work, said Telia Starks, St. Louis site director for American Home Care, which serves 1,900 clients throughout Missouri.

"It's like a domino effect," she said. "Some of our caregivers have been in the profession for 20 or 30 years, some are waiting to retire."

The Medicaid reductions were part of the governor's $27.6 billion spending plan for fiscal year 2018.

Greitens had to account for income tax revenue down by more than 25 percent through the first half of the budget year and lower revenue than the last governor and Legislature estimated.