Yes. First, Medicaid in South Carolina is over a dozen different programs. One program covers only poor children and another severely handicapped children whose parents are just slightly over federal poverty limits; one cov-ers poor pregnant women and another poor middle age women with breast cancer; the ABD program covers aged, blind and severely disabled persons, another homebound adults that need community long term care; and perhaps the best known is the program that pays for care for nursing home residents. Nationally Medicaid covers only 45% of poor Americans and income thresholds vary widely per state. In 20 states a single parent earning minimum wage with three dependents does not qualify.
Given the constraint of the State’s balanced budget legislation it is necessary to cut expenditures. Many publically supported activities contribute to our economic development by creating jobs and thus incomes that can be spent. The arts, tourism, parks and recreation programs benefit us all, but are not really in the same category as pro-viding for basic human needs and alleviating suffering. Nevertheless to be truly a net job and income generator, mon-ies must not merely reallocate tax dollars to a specific region or activity, rather monies need to flow from outside the State as is the case in export manufacturing and out-of-state tourist dollars. Medicaid has a really big effect in all 46 counties in South Carolina because of the generous federal match of $4 for every $1 contributed by South Carolina. A January 2002 report developed for the SC DHHS and researched by the USC Moore School of Business found the Medicaid federal match supports over 61,000 jobs and provides $1.5 billion in income for SC. The report further con-cluded that Medicaid’s ripple effect of purchasing health related supplies and business links for health service provid-ers for such things as cleaning services for clinics results in $2.1 billion annually spending for the SC economy!
Historically, weak state economies first threatened home and community based services and public oversight of nursing homes. In fact community based services were the first Medicaid cuts made by former Governor Stanford which were scheduled to take effect in early 2011. These cuts were quickly reinstated by Governor Haley, who is still studying the issues and asking President Obama for flexibility in meeting the minimum funding requirements. Interestingly the feds awarded $4.3 billion over the next 5 years to 13 states that had the foresight to expand their efficient cost saving community based care programs. SC was not one of them, but seven cash strapped states including Maine, Vermont, Minnesota and Mississippi will receive substantial funds.
A significant area of concern for future state funding are the dual program candidates, poor elderly who re-ceive Medicare, which pays something for rehabilitative care in a nursing home after a hospital stay for up to 100 days and nothing thereafter, but who reside in nursing homes because of dementia and frail health. These people, who ac-count for over 40% of all Medicaid funds spent, rely on Medicaid because it is the only true long term care insurance for the majority of Americans.
A subcomponent of medical care is caregiving. Currently between 33% and 64% of non-professional care-givers often family members are employed and 49% of working caregivers are men. It’s hard to get accurate numbers because we might see ourselves as just overseeing Dad’s medications or driving Mom to the doctor or taking time off from work again for a chronically ill spouse or beloved handicapped child. We do know that as of 2010 there are 183,000 unpaid Alzheimer’s caregivers in South Carolina. Without even counting situations where the care receiptant is under age 50, working caregivers represent a huge cost to corporate America. MetLife has given us an annual fig-ure of $2,110 per employee for absenteeism, workday interruptions, unpaid leave, full to part-time work, eldercare crisis and employee replacement, or $33 billion nationally.
We want to age at home. We also want our disabled and frail elderly population to live the least restrictive lives possible, at home or in homelike settings. We have seen dramatic improvements in the quality of life for our most vulnerable population. We need to be very careful not to destroy decades of progress with sweeping budget cuts. Small changes like moving toward community based home care can have a positive and economical effect on the bottom line. We need politicians to really understand the big picture and start thinking outside the box.
There is an old saying, but for the grace of God there go I. My own extended family has received Medicaid benefits. After being laid off Medicaid became a true life saver for a mentally-retarded-niece with major health issues who had stocked grocery store shelves about 30 hours a week for 20 years and was able to earn just enough to cover her private medical insurance and basic living expenses. Her parents had previously filed bankruptcy due to their own medical bills while pursuing disability. And then there was a blind elderly relative whose personal funds and assets were depleted by 10 years of nursing home care. Of course we helped financially, but few of us can afford an extra $5,000 a month or the entire cost of a major surgery or hospital stay. Many, if not all, of us will face heart wrenching decisions about family members and Medicaid. When the time comes we will want compassion, not the axe.
Disclaimer: Information contained in this column is meant to be of general information on frequently asked questions concerning disability, elder law, estate planning and probate law, and does not contain specific legal advice to a client. No attorney-client relationship is created by reading this column.
i “Test Your Knowledge of Medicaid”, Website lindafarronknapp.com articles.
ii Consumer Voice “Statement for House Hearing on Medicaid: Preserve Protections for People Receiving Long-Term Care”, March 1, 2011.
iii SC Medicaid Bulletin, “Medicaid Reductions”, December 14, 2010.
iv AARP Bulletin, “State Deficits Graph” (Center on Budget and Policy Priorities), Jan-Feb 2011.
v Cindi Ross Scoppe, Associated Editor, The State Newspaper, Opinion “the health law we ought to address”, Wed, Feb 9, 2011.
vi “Business, Caregiving and the Bottom Line”, Caregiverslibrary.org.
vii AARP Bulletin, “Alzheimer’s Disease Facts and Figures, March 2011.
viii Business, Caregiving and the Bottom Line”, Caregiverslibrary.org.