Bill Would Provide Long-term Care For Middle-class

Many Now Have To Sell Off Possessions To Get State Aid

March 17, 1991|By Adam Sachs | Adam Sachs,Staff writer

ANNAPOLIS — Mid-income senior citizens in need of long-term nursing care shouldn't have to impoverish themselves to qualify for public health benefits, Delegate Donald B. Elliott, R-Carroll, Howard, told a House committee.

Elliott's proposed alternative to the state's current MedicalAssistance Program for the elderly was hailed by the House Economic Matters Committee chairman as a "very worthy project" and by a lobbyist for seniors as a "very progressive idea."

The delegate's bill would establish a "Maryland long-term care-security program" that would furnish the same services as provided under the Medicaid nursing home program for enrollees who have purchased a state-approved insurance policy for long-term care.

Seniors would be eligible for the program once they have exhausted all benefits available under their private insurance policy and met any other requirements established by the state Department of Health and Mental Hygiene.

Once the insurance policy ran out -- probably after three years of nursing home care, Elliott said -- the state would pick up the cost of long-term care, at Medicaid rates. Medicaid is the federal program that provides medical assistance payments for the poor.

Currently, seniors must be below certain income and asset levels to qualify for Medicaid, which means they often must sell homes and other property, or "spend down."

Elliott said his proposal would pool private and public sector resources to "eliminate the frightening prospectof senior citizens' facing impoverishment," while saving the state money at the same time.

Nursing home care expenditures make up the bulk of payments disbursed through Maryland's Medical Assistance Program. A legislative analyst determined that the state could save moneythrough Elliott's program by eliminating up-front assistance payments for enrollees with insurance policies.

However, if the federal government did not participate once the enrollee became reliant on assistance, the state might have to establish a limit on how long an enrollee could be in the program, said the analyst. He estimated the state would break even on costs after an enrollee is in the program for about four or five years. Savings would depend on the average length of stay in a nursing home and the average cost per enrollee.

The bill bars the health department from operating the program if it couldnot demonstrate to the legislature that total state expenditures would be less than without it.

Several states are pushing a similar bill in Congress that would waive the "spend down" requirements for those with certain insurance policies, requiring the federal and state governments to pick up the nursing home tabs once the benefits expire. It is not expected to pass soon.

Elliott noted that the AmericanAssociation for Retired Persons opposes the legislation, fearing a diminished government role.

"This is a very innovative program," Robin Shaivitz, a lobbyist for the Maryland Association of Non-Profit Homes for the Aging, told the committee Wednesday. "Maryland could be on the cutting edge of something very exciting for the nation.

"It's very devastating for seniors who not only have to go into nursing homes but have to spend down on everything to get in. It's built intothe bill that it can't be done if it doesn't save money, so it can'thurt to try it."

Elliott said his bill provides little more than a concept and a framework. A major obstacle to overcome is the high price of long-term care insurance, he acknowledged.

Elliott recommended that the program be launched as a pilot project, starting with alimited group of enrollees with whom the state could keep in close contact to analyze the program's effectiveness.

Several county advocates for seniors, while not familiar with the bill, said changes must be made to alleviate the high costs of health care for the elderly and the sacrifices they must make to receive it.

"We'd certainly be in favor of legislation that adds a safety net level for seniors," said Geoffrey Black, chairman of Carroll's Advocacy Group for the Elderly. "It sounds like a concept that would have possibilities as longas it doesn't take away services from anybody."

Sharon Baker, client services supervisor at the Carroll Department of Aging, said mostseniors don't purchase long-term health policies.

"For seniors togo out and buy that, it's very expensive," she said.

Baker said the cost depends on age and existing medical conditions, making it less expensive to buy such policies at middle age.

"Most bills introduced for health insurance and long-term care are just Band-Aids," shesaid. "I have to look at the federal level. We're one of two industrialized countries (South Africa is the other) which don't consider health care as a right."

Staff writer Anne Haddad contributed to this story.

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