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A proposal to cut Medicaid payments to assisted living facilities and limit the help the program provides to elderly and disabled Arkansans in their homes cleared the Legislature's public health committees on Monday.

The changes, affecting the 8,800 Arkansans served by the ARChoices program and 1,200 Medicaid recipients in assisted living facilities, are part of the state's efforts to slow the growth of Medicaid spending by enough to save $835 million from the fiscal year that started July 1, 2017, through fiscal 2021.

The proposal would reduce the rates paid to assisted living facilities by nearly 22 percent and set annual, per-person caps on the in-home help provided to participants in the ARChoices program.

The House and Senate Public Health, Welfare and Labor committees' vote during a joint meeting came despite complaints from providers and beneficiaries that the changes will cause assisted living facilities to go out of business and more disabled residents to end up in nursing homes, where the cost of their care will be higher.

"I'm coming here today to beg you to have a heart and get rid of this [proposed] system, because I'm afraid it's not going to allow enough hours [of care] to meet the needs of the disabled community," said Ann Ledgerwood, reading a statement written by her son, Bradley, a 37-year-old ARChoices recipient who lives in Cash and has cerebral palsy.

ARChoices provides in-home help with daily living tasks and other needs for low-income people with disabilities severe enough to qualify for placement in a nursing home.

The Department of Human Services proposal would cap ArChoices benefits at $30,000 a year for recipients with the greatest needs -- those who require total or extensive assistance with moving from one place to another, eating and using the bathroom.

Enrollees requiring assistance with only two of those activities would be eligible for up to $20,000 of care. The annual cost for those with less extensive needs would be capped at $5,000 each.

Enrollees who are currently receiving more than $30,000 would be allowed to continue receiving their current level of care in 2019 and 95 percent of that amount in 2020.

The state would also scrap an algorithm currently used to assign recipients to "resource utilization groups" based on their medical diagnoses and answers to questions about their needs.

Instead, the hours would be calculated based on an estimate of how many minutes of assistance the recipient needs with tasks such as dressing, eating and bathing.

Mark White, deputy director of the Human Services Department's Aging, Adult and Behavioral Health Services Division, said the changes to the ARChoices proposed rules will give the department more flexibility to tailor the service allocations for each enrollee.

The current system has been the subject of lawsuits by Jonesboro-based Legal Aid of Arkansas, which contends that use of the algorithm resulted in widespread cuts in the hours of care that recipients can receive.

Legal Aid attorney Kevin De Liban said the new system would increase the hours of care that recipients can receive from about five and a half hours a day to about six and a half hours.

That would still be fewer hours than many recipients need, he said. And some recipients with severe disabilities could end up with fewer than the maximum number of hours, depending on how the new assessment system works, he added.

Before 2016, De Liban said, recipients could receive about 7 hours a day under a program serving the elderly and about eight hours a day under one that served younger recipients.

Both programs were combined to create ARChoices in 2016.

Sen. Missy Irvin, R-Mountain View, noted Monday that the proposed system attempts to address criticisms of the state's current method for awarding hours by giving Human Services Department nurses more discretion in awarding hours.

For instance, recipients would be able to request a one-year increase in the cap on services "to address exceptional circumstances."

"I'm starting to wonder if there's ever going to be a solution, or are you going to just continually be against any type of an assessment tool that we have to use?" Irvin asked De Liban. "At what point are you going to be satisfied?"

De Liban responded that the state could make adjustments, such as increasing the annual cost caps, that would provide recipients with the care they need.

"I'm the one that people call when they're lying in their own feces, when they're saying that I can't drink a sip of water after 5 o'clock at night because that means I'll have to sit in my diaper longer before my care aide comes in the morning," De Liban said. "To the extent I am critical, I'm critical because my clients are critical because they need enough care."

White said the rate cut for assisted living facilities resulted from an actuarial study commissioned by the department.

Currently the state classifies the residents into four tiers, based on the severity of their needs, and pays the facilities corresponding rates, ranging from $70.89 to $85.35 per resident per day.

Under the Human Services Department's proposal, the state would pay the same rate regardless of a resident's condition. It would start at $80.33 per resident, per day next month, then drop to $71.61 in July and $62.89 in 2020.

According to the waiver authorizing the program, the current rate was the result of negotiations between the department and providers in 2002 and automatically increased each year.

As a part of the waiver's renewal in February 2016, the department agreed to implement a new "rate methodology," White said.

The department wants to amend the waiver so that it can start using a new assessment tool to determine eligibility for the program. Federal officials are unlikely to approve that change unless the state also submits a new rate backed by an actuarial study, he said.

"This is going to hurt a lot of facilities," said Ed Holman, chairman of the Arkansas Residential Assisted Living Association. "They built their models for" the current rate.

White said some assisted living facilities have been struggling, even under the current rates. Some were built with public financing restricting them to serve only low-income residents, making it harder for them to attract residents who are not on Medicaid.

With the number of Arkansans who can receive the assistance capped at 1,200, "I don't know that it ever made sense to have a business plan that was entirely dependent on those Medicaid beds," White said.

In a voice vote, with no members objecting, the committee declared the proposed rate and rules "reviewed."

Gov. Asa Hutchinson in 2015 set the goal of slowing the growth of spending in the traditional Medicaid program by enough to cut spending by about $167 million a year, or $835 million over five years, to help pay for the cost of expanding Medicaid.

The changes reviewed by the committees on Monday would reduce spending on in-home facilities by $7.8 million and on assisted-living facilities by $4.6 million in their first full fiscal year, starting July 1, Human Services Department spokesman Marci Manley has said.

That's about 4 percent of the total spending each year on the two programs combined, she said.

The proposal will go to the Legislative Council's Administrative Rules and Regulations Subcommittee for approval on Dec. 18 and the full council on Dec. 21.

A Section on 12/11/2018

Print Headline: Proposal to cut Medicaid payments to assisted living facilities, limit in-home help advances


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Archived Comments

  • Knuckleball1
    December 11, 2018 at 7:07 a.m.

    AS I stated the other day, this group in charge wants to play GOD and decides who lives and dies in the Natural State.

    Instead of going after the crooks that abuse the system (it might be some of their friends or supporters with deep pockets)they are set to punish the people that need the services the most. There is going to be a reckoning one of these days for these want to be Gods. The Voters keep putting them back into office but I have a feeling that at the Pearly Gates, St. Peter may be a bit tougher and deaf to their slick tongues and send them where the serpents need to go.

  • hogfan2012
    December 11, 2018 at 9:08 a.m.

    Those dumba**es are trying to figure out why costs are escalating and there is more demand for this type of service? It's called baby boomers getting older!!! There are millions of us. We are the people who have worked for the last 40+ years to take care of the previous generation with our tax dollars. Now that it is time for our generation to need help, there is not enough $$ to go around.

  • ZeebronZ
    December 11, 2018 at 9:27 a.m.

    Pretty much a death sentence for those who depend on Medicaid for in-home care and assisted living.

  • RamblingRose
    December 11, 2018 at 11:14 a.m.

    This is a classic case of an attempt to balance a budget on the backs of people who can't help themselves or defend themselves. I for one think it is a good use of my tax dollars to ensure that the elderly and disabled have a decent quality of life, and I urge my elected representatives to find a more humane solution.

  • CarpeNoctis
    December 11, 2018 at 12:14 p.m.

    I appears, more and more each day, that we are being held hostage by a group with no heart and no souls, all in the name of cutting spending, though we keep hearing about how employment is up, tax collections are up. If so, why then are the elderly and infirm having to live in their diapers for hours at a time, all because of an arbitrary "assessment" by whomever on hours they have to wallow in their own filth. Please please, vote these "people" out of office.

  • mrcharles
    December 11, 2018 at 1:38 p.m.

    Can we not just do personal responsibility and just put those who cant cut it on ice flows and let them just go into the by and by? After all, personal responsibility works well as the only thing that counts, anyway for some.

    And I would add dont give me any of that christian love talk, that is just for talk and feel good. While many follow that most of the ones who also are the conservative type, have a bag of excuses to excuse their avoidance of good things, as meanness seems to drive their mind set.

    As we only spend half the world's expenditures on military, we are in danger of space aliens , so people like tommmy cotton tell us we need to not be whimps and with only so much money to go around, we need flying coal fueled aircraft carriers , or such. The widow, the orphan, the alien, the poor, are just words anyway.

    knuckle, there is advantages to being a sheep instead of a trump goat.

  • 0boxerssuddenlinknet
    December 11, 2018 at 2:38 p.m.

    please correct me if I'm wrong, but it seems to me that there is a certain amount of money in a pot or category that is set aside or budgeted for the ARChoice program to help the disabled in Arkansas.However if the number of disabled keep growing using the same bucket of money. and EVERYONE agrees we need to take care of the disabled. then we need to INCREASE the amount of money in that bucket. so, I'm sure everyone would be more than glad to see their taxes increased to help out our needy. How about it ? I'm in.

  • Winfield
    December 18, 2018 at 6:40 a.m.

    Death panels are starting to form.