A suffering Colorado economy may mean 25 percent of the state’s elderly who qualify for Medicaid will no longer be eligible for essential medical assistance.
“The recent shortfall in the Colorado state budget is forcing Medicaid to become much more strict in their admissions process, eliminating those participants who do not have what the state strictly defines as a serious medical need,” said Ruth Coberly, division manager for the Senior and Disabled Programs at the Department of Human Services in Larimer County.
Medicaid is a jointly funded, federal-state health insurance program for certain low-income and needy people.
“Yes of course we need to make cuts,” Coberly said. “But we are concerned that this application process is bordering on inhumane.”
The proposed tool, known as the Uniform Long Term Care Assessment instrument, forces the applicant to demonstrate serious medical need by being evaluated in six daily performances including eating, dressing, toileting, mobilizing, transferring and bathing.
Under this plan, people who need medical assistance for things like remembering how to perform daily functions will not qualify for the program, Coberly explained.
In order for applicants to qualify for Medicaid using the ULTC-100 they must score at least two in severity in a range from zero to three in at least two of the six areas of assessment by a designated caseworker.
“This will eliminate those patients that might need medical care but do not meet the criteria for what the medical board defines as serious medical care,” said Roger Doherty, staff member at Colorado Gerontological Society.
In preliminary studies of the new criteria for admission, which was passed by the Colorado Medical Board on first reading Friday, about 25 percent of people who currently qualify for Medicaid will be dismissed from the program, Coberly said.
The final vote is expected to come in March.
Under Colorado’s current Medicaid program participants are able to take advantage of home care based services. Many participants opt for this service because it allows them to receive medical care while still living in their home, instead of moving into a nursing facility.
“Because these people are still able to function at home they will be the most likely group to be cut by the new application process,” Coberly said.
But supporters of the new process claim Medicaid was never meant for in-home care.
“Medicaid must not be paid for room and board except in nursing facilities,” said Julie Reiskin, supporter of the measure and member of the Medical Board.
But this leaves people like Coberly wondering why the government would eliminate those participants who are the cheapest to care for.
“Comparing the in-home care to nursing facilities, which run about $3600 a month, it is a lot cheaper,” Coberly said. “In-home care is saving the taxpayers between $200 and $300 a week; it just doesn’t make sense to cut it.”
In addition to being able to live at home, under the home care based services participants are allowed to attend the adult day care services.
The Fort Collins Elderhaus, a non-profit adult day care center, cares for people, mainly elderly, allowing them the comfort of a home away from home and a needed break for caretakers.
A majority of these terminally ill people may be in jeopardy of not only losing valuable friendships and needed comfort provided by the Elderhaus, but are at risk of losing vital and necessary medical care.
So with the cuts likely to run deep in this area, according to Coberly, such non-profit entities may be in danger financially.
“About 65 percent of the Elderhaus’ visitors are on Medicaid,” said Joann Johnsen, executive director of the Elderhaus. “The rest of our funds come from private donations and tuition.”
In the last year, the Elderhaus has already found itself struggling financially in the lack-luster economy.
“We got cut along with other agencies from the city because of the soft economy,” Johnsen said. “It has made it really hard.”
Not only will this new application process eliminate potential participants but it will also eliminate those who have been in the program for years, Doherty said.
“No one is grandfathered in,” Coberly said.
Because each Medicaid patient is evaluated yearly, the new application process will begin to weed people out of the program as early as April, when the new process begins, Doherty said.
Some of the people who will be dismissed from the program will be able to pick up insurance through Medicare, a federally-funded insurance plan for the elderly, but long-term medical care and prescription drug costs are not covered, Coberly said.
With a financially struggling state, options appear scarce for those who will no longer qualify for the program. “No one has really come to the forefront,” Doherty said. “What is about to happen in Colorado is very scary and dangerous.”
But Reiskin and other supporters of the measure said the new Medicaid procedure should not be held responsible.
“If (Medicaid patients who may no longer qualify) are evicted that is something the assisted-living industry needs to answer,” she said.
Still, many advocates for the elderly are left wondering how the estimated 25 percent of Medicaid patients who will no longer qualify for the program will afford medical care without long-term medical assistance.
“I hope Colorado doesn’t do this,” Coberly said.