Support growing for at-home care

Bill would expand Medicaid coverage of assisted living

Governor backs plan

Current program leaves state behind others, advocates say

February 27, 1999|By Gady A. Epstein | Gady A. Epstein,SUN STAFF

Maryland could expand Medicaid coverage to thousands of seniors receiving medical care at home or in assisted-living facilities under legislation heard yesterday that appears to be gathering strong support.

Under the bill, which received the governor's tacit endorsement this week, Maryland could join more than 40 other states that offer Medicaid coverage to large numbers of infirm people who are eligible for nursing homes but prefer to be cared for at home or in an assisted-living facility.

With medical bills that can run up to several thousand dollars a month, many seniors now are forced to either spend themselves into poverty or enter a nursing home covered by Medicaid.

"For many of our seniors, staying at home is the best option," said Wayne Thomas Duncan, a Baltimore County firefighter testifying before the Senate Finance Committee yesterday. Duncan's parents committed suicide last fall after his father was forced to put his mother in a nursing home. "Why are we separating our loved ones from each other?"

The bill, sponsored by Baltimore County Democratic Sen. Paula C. Hollinger, calls for the state to ask for a federal waiver to cover at-home and assisted-living care for up to 7,500 people. Maryland has a more limited Medicaid waiver that covers assisted-living facility care for fewer than 100 people, leaving the state far behind most others, advocates say. The Medicaid program already pays for cheaper in-home care for thousands of very poor people.

After months of negotiation, the Glendening administration decided late this week to back the proposed Medicaid expansion, but it wants strict controls on the cost, which could be as much as $20 million a year. For that reason, advocates expect that the program would start out small next year -- with as little as a few hundred people -- and expand by about 1,000 people a year after that.

"We have to make it manageable," said Don Vandrey, a spokesman for the governor.

Supporters say the legislation would cost little compared with the more than half-billion dollars spent each year in Medicaid payments to cover fewer than 20,000 people in nursing homes. They also say the bill would lead to some savings because assisted-living facilities and home care can cost thousands of dollars less per month than nursing homes.

"It could be a very low monthly cost," said Sen. Leonard H. Teitelbaum, a Montgomery County Democrat who was involved in negotiations on the bill. "It could be a few home visits a week or month."

Some of those savings, however, would be poured back into the Medicaid program to boost nursing home payments, an apparent carrot to sidestep opposition from the nursing home industry.

House and Senate leaders also are expected to scrutinize closely the bill's cost before moving ahead, but supporters say winning the administration's backing was the toughest hurdle. The Glendening administration could ask for the Medicaid waiver without legislation but has balked in the past because of concerns such as cost and whether the federal government would approve the waiver.

Federal officials have been privy to the negotiations over the Hollinger bill, and supporters expect approval of the Medicaid waiver if the legislation passes. More than 40 states have received similar waivers.

"Other states have moved ahead," Hollinger said yesterday. "We are practically at the end of the line."

Pub Date: 2/27/99

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