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Gauge cuts Medicaid assisted-living eligibility rolls

by Andy Davis | June 3, 2019 at 4:30 a.m.

Large numbers of elderly Arkansans are being told they no longer qualify for help from state Medicaid to pay for their care at an assisted-living place as a result of an eligibility assessment tool the state began using this year, facility owners say.

Among those found to no longer qualify is Bobbie Brown, 86, who has lived at the Hope’s Creek assisted-living facility in Van Buren since September 2015.

B oth Brown and her daughter, Kathy Davern, said they don’t understand why she was found to be ineligible this year after being found eligible in previous years.

“I go to bed and I think about it, and I can’t hardly sleep,” Brown said.

Based on a tool developed in Minnesota, the Arkansas Independent Assessment measures the needs of Medicaid recipients based on a series of up to about 400 questions.

Under a contract with the state Department of Human Services, nurses with Optum Government Solutions, a division of Minnetonka, Minn.-based United Health Group, began using the tool this year to help determine eligibility for two programs serving elderly or disabled low-income Arkansans.

One is the assisted-living program, which serves up to 1,200 people in 60 facilities around the state. The other is ARChoices, which provides in-home care, including help with daily living tasks such as dressing and bathing, to about 8,800 Arkansans.

Previously, Human Services Department nurses performed assessments for the two programs using a different tool, known as the ArPath.

Of the 331 people who have been assessed for eligibility for the assisted-living program this year through Thursday, 146, or 44%, were found to be ineligible, Mark White, deputy director of the department’s Aging, Adult and Behavioral Health Services Division, said in an email.

Those found to be ineligible included 78, or 47%, of the 165 residents who have been assessed this year who had previously been found eligible after assessments using the ArPath.

Similarly, 951, or 31%, of the 3,047 Arkansans assessed for eligibility this year for ARChoices were found to be ineligible.

That included 27% of those who were assessed who had been previously found to be eligible and 37% of new applicants.

When they proposed a rule change last year allowing the use of the new tool, Human Services Department officials indicated that the change shouldn’t affect most recipients’ eligibility.

They said the underlying eligibility criteria hadn’t changed and that the final determination of eligibility would still be made by nurses at the department’s office of long term care.

“If someone is eligible for ARChoices today, they will be eligible for ARChoices after this reform is made,” White told the state House and state Senate public health committees in December.

White noted in the email that recipients found to be ineligible can file an administrative appeal. Residents found ineligible for the assisted-living program or AR-Choices may still be eligible for other Medicaid-funded services, such as nursing home care, he said.

Jonesboro-based Legal Aid of Arkansas fielded calls from about 40 ARChoices recipients in a two-month span who were notified that they were no longer eligible for the program, Legal Aid attorney Kevin De Liban said.

In several cases, after the recipient hired a Legal Aid attorney the department ordered Optum to conduct a new assessment, De Liban said.

In at least three or four cases, the new assessment produced a different result than the first one, leading the department to drop its bid to terminate the recipient from the program, he said.

“We have had some assessors who’ve been apparently not taking very much time,” De Liban said. “They’re asking confusing questions, and it’s not always clear which one matters.”

Hope’s Creek owner Todd Hightower said that out of 55 residents of that facility and ones that he owns in Waldron, Malvern, Sheridan, Mountain Home and Crossett who have received assessments, 34 were found to be ineligible and are now appealing that determination.

Most sold their homes before moving into one of the facilities and would not be able to pay the $2,700 to $3,500 per month it would cost them to stay at the assisted-living place without Medicaid’s help, he said.

“I don’t know where they’re going to go,” High-tower said. “That’s the question. I would hate to see people being put on the street.”

Like the ArPath, the Op-tum assessment classifies people according to their ability to perform three tasks: eating, using the toilet and moving from one place to another, such as from a bed to a chair.

To qualify for assistance, the subject of the assessment must require extensive assistance with one of those tasks or limited assistance with two of them.

Those criteria didn’t change when the state started using the Optum assessment, but the new tool uses a different method than the ArPath did to classify recipients or applicants according to their level of need.

Human Services Department officials have said they switched to the new system because it is the same tool used to assess Medicaid recipients with mental illness and developmental disabilities.

The Center for Information Management, a Michigan company that provided the software platform for the ArPath, also didn’t want to keep providing the service, White has said.

Facility owners say the Optum nurses aren’t as familiar with the residents as the Human Services Department nurses were, and that the residents often downplay the extent of their disabilities.

The new system also uses a different criteria than the old one did to determine eligibility for residents with dementia.

Under the old system, a recipient or applicant whose cognitive abilities were considered at least moderately impaired could qualify.

Now, the person must have a diagnosis of a mental disorder such as dementia, have impaired mental functioning and have a history of behaviors such as being aggressive toward others, presenting a danger to themselves or displaying socially unacceptable behavior.

Cindy Gehring of Fort Smith said that, although her 87-year-old mother, Martha Chaney, who lives at Hope’s Creek, has been diagnosed with dementia, an Optum assessment found her ineligible for the assisted-living program.

Before she moved to the facility about six months ago, Chaney broke into the lock-box at her house in Wichita, Kan., where her medication was stored and sorted the pills out on the floor according to size and color, Gehring said.

She said her mother still has to be reminded to eat at Hope’s Creek and gets lost in the hallways of the facility.

While Gehring’s home was flooded last week, forcing her to stay in a hotel, her mother, during a phone call, was more interested in being reminded what channel

Everybody Loves Raymond

reruns are on, than learning about her daughter’s plight.

“I would argue till my last breath that my mom has got to have this,” Gehring said. “To be told that she can live on her own, [which] I guess is what they’re saying, makes absolutely no sense to me.”

Scott Kingsboro, who owns assisted-living facilities in Little Rock and Benton, said about five of the residents at his facility who have been found to be disqualified have dementia.

Four others were disqualified because they have regular blood pressure or blood glucose checks, he said.

According to a copy of the assessment’s scoring system, residents who have such tests performed daily by a nurse, physical or occupational therapist or physician are considered ineligible to live in assisted-living facilities because they require nursing home care.

But Kingsboro said nurses at his facilities check diabetic residents’ blood glucose, and a nursing assistant checks their blood pressure.

“It just boggles the mind,” he said.

Brown’s daughter, Kathy Davern, said her mother has been diagnosed with dementia and had a stroke before moving into Hope’s Creek.

Brown said she can eat, move from one place to another and use the toilet without help, although she does use a walker and needs help taking a shower.

If she had to move in with Davern and her husband, Brown would be left alone most of the day while they both work, Davern said.

She said she’s afraid her mother would have another stroke while alone in the house and wouldn’t be found until hours later. That’s what happened in 2015, before Brown moved into Hope’s Creek, Davern said.

“I’m afraid she’d fall,” Davern said. “In her mind, she thinks she can cook, and that would scare me.”

Brown said Hope’s Creek “isn’t like home,” and she doesn’t always like the food there. But she said she’s safer there than she would be at her daughter’s house.

“There wouldn’t be anybody there” during the day, Brown said. “I would just be on my own.”


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