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.

To help those losing assistance stay in their homes, the state has created a limited program called Essential Community Supports that will cover a smaller number of home-based services. The payments under the new program, which is funded by the state, are limited to $400 a month.

Loren Colman, DHS assistant commissioner of continuing care, said the changes are necessary to preserve the long-term sustainability of Medicaid. Medical assistance programs account for 25 percent of the state's general budget, up from 17 percent in 2005, according to the Minnesota Budget Project, a nonpartisan research group that focuses on budget and tax issues.

"If we don't make these changes today, then we are that much closer to the demographic changes that are going to test our system and make it unsustainable," Colman said.

Will health be affected?

Across Minnesota, senior citizens and their families are already starting to learn that they may no longer qualify for assistance under the new rules.

Fred Johnson recently learned from a county official that his 83-year-old aunt, Mary Jane Jennings of St. Cloud may not qualify for home-based care through Medicaid..

Johnson, a portfolio manager at an investment firm, said his aunt moves with a breathing tube hooked up to an oxygen tank, which limits her mobility. She needs help with bathing, vacuuming and other chores and recently had a serious fall that sent her to a hospital for four days, Johnson said.

Relatives "found her lying on the ground with her breathing tube partially disconnected," Johnson said. "We're just thankful she was able to call 911, or she could have been gone."

Johnson questioned whether the state will save money by denying her home-based care. "It seems to make a whole lot more sense as a taxpayer to pay a few hundred dollars a month to help her stay in her own home," he said, "because if she falls again then it will cost the state many times more in hospital and nursing home bills."

Professional caregivers, whose hours would be cut under the new rules, are concerned that limiting services for elderly who struggle with even one basic living need could have a profound effect on their health.

A frail person who is unable to get in and out of a bathtub or stand long enough to cook a meal is at a greater risk of illness or hospitalization, caregivers warn. Some elderly people may no longer be able to afford assisted-living facilities without the waiver and may be forced to move in with relatives, they said.

"It's crucial to remember that things can go downhill very fast for [older] people who are vulnerable and frail," said Patti Cullen, president and chief executive officer of Care Providers of Minnesota, an association that represents senior housing providers. "Your change of status can happen very quickly, and we don't have strong confidence that the process is set up to adjust to those changes."

At Rainbow Terrace, word of the planned changes was a topic of discussion at the holiday party, where Robinson arrived with two sweet potato pies and a tray of potato salad.

"You've got a lot of folks in here who sit back and pretend like they don't need anything, but you know they're hurtin'," she said. "I just hope we don't get to a point where it takes a crisis for them to get some help."

Chris Serres • 612-673-4308