Advocates say new Medicaid rules for home-based care are shortsighted.
Starting in January, thousands of low-income elderly Minnesotans could lose government benefits intended to help them stay in their homes and out of nursing care.
In an effort to constrain runaway Medicaid spending, Minnesota is implementing stricter rules that will make it harder for senior citizens to qualify for home-based services, potentially leaving them with reduced care or no care at all.
An estimated 2,800 low-income senior citizens who currently receive Medicaid and other state assistance to help with basic living chores, such as bathing and cooking, would no longer qualify for help under the new rules.
State officials say the changes are necessary to preserve Medicaid, a program for the poor funded by the federal and state governments, before the baby boomer population overwhelms the system. Left unchecked, Medicaid costs threaten to cut into spending on other public services, such as schools and roads, state officials say.
The state Department of Human Services (DHS) says the changes will save taxpayers nearly $50 million in the next four years.
But many low-income senior citizens and their advocates fear that limiting access to home-based care could cost taxpayers more in the long run by pushing thousands of seniors out of their homes — potentially reversing the decades-long gains that Minnesota has made in reducing dependence on nursing-home care and helping people stay in their communities.
“It’s troubling to us that we may be moving backwards,” said Mary Jo George, associate state director of advocacy for AARP, which has 650,000 members in Minnesota. “The people who are losing these services are those who are already living in their homes and in their communities.”
Paying for fewer services
Ever since Dorothy Robinson saw the inside of a nursing home, with patients crammed into antiseptic rooms with unmade beds, the retired machinist vowed that she would never let her friends and family die in an institution.
At Rainbow Terrace, a public housing high-rise for seniors in north Minneapolis, Robinson, 72, makes it her mission to help frail and aging residents obtain home nursing care through Medicaid and other programs that provide care for the poor.
“My father died in my arms, in his own home,” Robinson, said as she sliced potatoes for a holiday dinner party. “I think everyone has a right to die like that, with grace and dignity.”
But tough new rules that were enacted during the recessionary budget crisis of 2009 — and put on hold until now — could make it harder for Robinson and other seniors to live out their final years in their homes.
Those most affected by the changes are the 22,600 low-income Minnesotans currently enrolled in Medicaid’s “Elderly Waiver” program.
The waiver helps seniors stay in their homes by paying for services such as visits by a skilled nurse and supplies such as medical walkers. The average monthly benefit is about $1,200 per senior.
Until now, it has been relatively easy for poor Minnesotans to qualify for the program. It was enough to show that they needed assistance in one basic activity of daily living, such as help with bathing or dressing.
Under the new criteria, seniors must show that they need assistance in at least four activities of daily living; or, alternatively, they need help in a single critical activity such as toileting or transferring, for example, moving from a bed to a wheelchair.
The tougher rules come with safeguards. DHS officials say seniors will not lose the Medicaid waiver if they are at risk of homelessness or self-neglect; or have suffered a fall resulting in a broken bone within 12 months, among other protections.
DHS estimates that about 2,600, or 11 percent, of Minnesotans currently benefiting from the Elderly Waiver program would not meet the tougher criteria. It predicts another 175 seniors could lose benefits through a smaller program, called Alternative Care, which pays for services such as adult day care and home-cooked meals.