Savings from cuts to in-home care fall short of projections

JEFFERSON CITY, Mo. -- A report released Wednesday by Missouri Auditor Nicole Galloway found cuts to in-home care for seniors and people with disabilities didn't end up saving as much money as expected.

The review found ramping up eligibility requirements for the program saved about $11 million last fiscal year compared to the year before. That's far less than the $43 million in savings the state's health department had estimated when cuts to the program took effect last year.

"The savings have been overestimated, which cause greater budget challenges and, often, the need for supplemental appropriations," Galloway said. "More realistic estimates would have helped avoid those problems."

At issue are in-home and community-based services that include help with bathing, cleaning and taking medicine.

Lawmakers in 2017 passed a budget cutting the Medicaid-funded personal care services by requiring participants to show a greater level of disability in order to qualify for the aid.

Savings from that cut ultimately came up short, according to Galloway's office.

That's partly because many people still qualified for the program after being re-evaluated, despite the more stringent requirements. Galloway said the state Department of Health and Senior Services didn't take into account recent trends that show some participants will qualify for a higher level of care in later evaluations.

The number of people who were ranked as needing more help than before also shot up last fiscal year, Galloway's office noted.

The uptick "creates questions as to whether some participants were improperly found to remain eligible for services," according to the review.

The report notes the Department of Health and Senior Services is taking steps -- such as increasing staff training and studying how other states handle similar programs -- to revamp its process for assessing how much help, if any, applicants need.

Director Randall Williams, in a response included in the report, wrote the decision to give aid is "person centered and based upon the needs of each individual participant, taking into account available formal and informal supports."

Williams agreed budget estimates need to be better. But he wrote the criticism doesn't take into account the multiple financial projections based on different scenarios the agency provides to budgeters and Williams said have been on the mark.