Medicaid Cuts Based on Elderly's IncomesWe are writing in...


October 31, 1992

Medicaid Cuts Based on Elderly's Incomes

We are writing in response to Laura Lippman's Oct. 21 article "Medicaid cuts would hit elderly."

As the co-chairs of the Joint Administrative, Executive and Legislative Review Committee (AELR), we would like to take exception to the last paragraph which stated, "The Administrative, Executive and Legislative Review Committee is expected to act on the proposed regulatory changes in early November, clearing the way for the cut to take effect Dec 1."

As emergency regulations, the AELR Committee must vote affirmatively before the regulations become effective.

Should the committee not approve these emergency regulations, then, and in that event, the Department of Health and Mental Hygiene may choose to proceed with proposed regulations (which do not require AELR approval) which will take at least 90 days to become effective. In the latter case, of course, the date of Dec. 1, 1992 becomes inoperative.

Your readers should know that the AELR Committee has no statutory authority to negate this budget cut proposed by the governor and the secretary of health and mental hygiene. The committee may only delay its implementation by declining to approve the emergency regulations.

Sen. Paula C. Hollinger

' Del. Kenneth H. Masters

Your story on the Maryland Medicaid cap on nursing home resident incomes had at least two misleading statements and certainly minimized the human cost of this proposal.

To refer to the income of the Medicaid recipient as "earned

income" is technically incorrect. This income is from Social Security and pensions.

Milo Polchop, with a monthly income of $2,200 from SS and a pension, is an example that, as presented, implies that he receives almost enough to pay the private pay rate. It is highly probable that nearly half of his income goes for spousal support under the spousal impoverishment provisions of Medicaid regulations.

Now, let's get to the human pain involved here. Secretary Nelson Sabatini of the Department of Health and Mental Hygiene suggests day care or other alternative arrangements. Mr. Sabatini should know better.

The reality is that the people who are threatened can't go to day care because they need nursing care 24 hours a day. They are in a nursing home because they deteriorated to the point where they need a level of care greater than day care.

More than half the persons affected in the four southern counties of the Eastern Shore are certified as "heavy care" by the Delmarva Foundation, which assigns a level of care for Medicaid reimbursement.

I am certain that Mr. Sabatini knows what heavy care is in clinical terms. If you don't know, heavy care is this: These persons cannot feed, toilet, dress, bathe themselves or move purposefully.

They require a number of medical procedures such as gastro-enteral tube care, injections, catheter care and turning to prevent decubitus development.

Even intermediate and light care residents are often more than families can care for because of the behaviors associated with dementia. The level of care assigned is misleading if you think it indicates that families could care for these people who wander, scream every waking hour, sleep only intermittently and who are often violent.

The nursing home administrators who said they would absorb the cost should have been identified by facility and by type. I suspect they were church supported or have an endowment.

Most facilities, even private non-profits or county-operated homes, simply don't have these kinds of resources behind them.

This is a complicated issue that is not helped by simplistic statements or judgmental remarks.

And most importantly, older persons who are demented and/or very sick with medical conditions, cannot be cared for at home. And they and their families do not deserve to be frightened and destabilized by threats like this.

Yes, Maryland does have budget problems. But cutting services that mean the difference between life and death, services that guarantee a dignified existence for old people, is not the way to go.

Let's look at services that are optional. Let's defer more highways and bridges to vacation areas. Let's not build stadiums and subsidize the wealthy.

There are places in this world, Scandinavia for one, where it is safe to grow old. If we really want to say with truth and with pride that we're proud to be Americans, let's put our money where our mouth is and make this a safe place for all citizens, not just for the wealthy.

This proposal, if implemented, is cruel to families and nursing home residents. I find it unthinkable that our state leaders could even contemplate this.

If you agree with me, call your legislators. And call your local office on aging. I have no doubt that they are organizing a campaign that will make the governor, the legislature and all the citizens of the state pay attention.

Sandra Poole


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