Medicaid cuts would hit elderly Many likely to lose nursing home aid

October 21, 1992|By Laura Lippman | Laura Lippman,Staff Writer

The middle-class elderly in Maryland could be squeezed out of nursing home care as a result of state budget cuts.

Under a proposal to cut the state's $2 billion Medicaid budget, which must be approved by a legislative committee, anyone who earns more than $12,660 a year would no longer be entitled to subsidies for nursing home care.

Nursing home administrators said yesterday it is doubtful that any residents will be discharged for failure to pay. The nursing homes will simply absorb the costs. But the change would effectively keep thousands of people out of nursing homes, where private rates run from $36,000 to upward of $48,000 a year.

The proposal has left many elderly people wondering what their futures hold.

"Does the governor expect us to evaporate?" asked Jane Richards, president of the patients council at Keswick, a Roland Park nursing home.

Milo Pochop, 73, has been in Lorien-Frankford Nursing Home for two years. In that time, he and his wife, Mary, have run through most of his savings to pay the full rate of $3,000 a month. Now that he has only $2,200 a month from his pension and Social Security check, they were counting on Medicaid to cover the shortfall.

"I don't know what I'm going to do," Mrs. Pochop, 76, said of her husband, who is incontinent and must be tube-fed since suffering two strokes in 1990. "I can't bring him home. I can't handle him."

Doug Kaplan, of Germantown, is worried about his 80-year-old mother, Rose. Mrs. Kaplan, suffering from Alzheimer's, receives about $3,600 over the state's proposed annual income limit. Yet Mr. Kaplan, a sales representative who has debts from a failed business venture, said he could never afford the full cost of her care at Shady Grove in Gaithersburg.

"I have no extra funds, I'm scraping by," he said.

State officials said they had no choice but to cut Medicaid. The program's costs are spiraling nationwide, and nursing home patients account for a disproportionate share of those expenses. In Maryland, for example, nursing home patients are only 6 percent of Medicaid recipients, but are responsible for more than 20 percent of the costs.

Under federal regulations, the state could have set an even more stringent income standard than $12,660. The cutoff could have been as low as $5,064 annually, equivalent to Social Security payments to the disabled.

The proposed cut would save the state $7.6 million.

"This is not being done to be vindictive," said Nelson J. Sabatini, secretary of the Department of Health and Mental Hygiene. "It's being done because we have a half-billion [budget] shortfall. In terms of policy, it may not be a good long-term decision. But most of these cuts are not."

About 2,000 of the state's 17,500 Medicaid recipients in nursing homes now earn more than $12,660 a year through Social Security, pensions and other means. If their income is less than the nursing home's private rate, the state steps in and supplements their care, at slightly more than half the usual cost.

Mr. Sabatini said he expects some "ad hoc" arrangements to be made for some of those who lose subsidies. For example, he said, some residents may be able to live with their families, relying on attendants or adult day care for their needs.

However, Stewart Seitz, vice president of the Health Facilities Association of Maryland, said studies indicate that the majority of those affected have been in nursing homes for at least three years and need to be in nursing homes.

If patients who lose Medicaid subsidies remain in nursing homes, absorbing the costs will prove an expensive burden.

At the National Lutheran Home in Rockville, the staff is committed to continuing to care for the 25 residents who probably will lose their Medicaid, said assistant administrator Sharon Parver. That means a loss of $400,000 a year for the 300-bed home.

The Administrative Executive and Legislative Review Committee is expected to act on the proposed regulatory in changes in early November, clearing the way for the cut to take effect Dec. 1.

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