2003-08-21 -- Some Kentucky Medicaid Recipients Losing Long-Term Care


Kentucky residents losing Medicaid long-term care benefits is a
foreshadowing of what is to come.  Care for elders and people with
disabilities is an issue in restructuring of Medicaid as well as
Medicare. Long-term care or nursing home care is an "optional"
Medicaid benefit.  Instead of being mandated by Federal law, most
states have elected to cover some long term/nursing home care and
received matching federal money, so that Medicaid pays about half of
nursing home costs nationally.

Under proposed restructuring, Medicaid services would no longer be an
entitlement or a defined benefit, with federal funds matching state
expenditures.  Instead, states would receive fixed sums with tight
controls for inflation, and would be free to define who is covered by
Medicaid and what benefits would be covered. An additional wrinkle is
that federal funding for any long-term care would be a separate stream
with the potential of more stringent cost inflation controls.



Kaiser Daily Health Policy Report, Wednesday, August 20, 2003

Some Kentucky Residents Losing Medicaid Long-Term Care Benefits

More than 1,400 Kentucky residents currently receiving care in nursing
homes, at home or in community-based facilities are no longer eligible
for long-term care benefits under Medicaid, state Health Services
Secretary Marcia Morgan said on Aug. 18, the Associated Press reports.

Addressing the state Legislature's Medicaid Managed Care Oversight
Advisory Committee, Morgan said that between April and July the state
has "decertified" --  repealed eligibility for long-term care
benefits -- or denied admission to Medicaid to 198 nursing home
residents and decertified or denied admission to 1,209 people
receiving care at home or in community-based settings.

Beneficiaries who are decertified may still be eligible to receive
other Medicaid benefits, the Associated Press reports. The cuts are
the result of a decision by state officials earlier this year to
eliminate "personal care" benefits under Medicaid in an attempt to
offset a budget shortfall for the program (Biesk, Associated Press,
8/18). Kentucky's Medicaid program has a $4.4 million budget deficit
this fiscal year, and the gap is expected to increase to between $200
million and $400 million by 2005, Morgan said.

She added that 1,307 people have appealed the decertification or
denials (Ward, Lexington Herald-Leader, 8/19). Those who are appealing
the change are allowed to continue receiving long-term care services
during the appeals process. However, if they lose their appeal, the
beneficiaries or their families may be forced to pay for the care they
received during the process, which typically lasts between six and
eight months (Associated Press, 8/18).

State Rep. Paul Bather (D), co-chair of the advisory committee, on
Aug. 18 asked advocates for Medicaid beneficiaries and Medicaid
officials to work to develop strategies to "protect [beneficiaries']
rights and find additional resources" for the program (Lexington
Herald-Leader, 8/19).