A home health care nurse says a plan to save money on Medicaid would hurt many of the area's most fragile people.
At issue is a system the state's Medicaid regulators have developed to save on personal care services, which include in-home assistance with bathing, going to the bathroom and help Medicaid can pay for. More than 30,000 people get personal care services in North Carolina.
Brad Deen, a spokesman for the Department of Health and Human Services, said this year's budget for the services was $188 million. He said costs for the program rose higher than that within the first six months of the budget year, which started in July.
To solve the problem, the state Medicaid office developed a scoring system to determine how many hours of in-home help Medicaid would cover. The issue has been winding its way through North Carolina courts after the Association for Home & Hospice Care of North Carolina filed a legal challenge to block the scoring system.
Tracy Colvard, a spokesman for the group that represents home care service providers, said the dispute is over how the state is attempting the personal care services budget. He said the state Medicaid office is trying a shortcut instead of establishing the independent assessment the General Assembly asked for in order to cut Medicaid costs.
In February, a judge told the state Division of Medical Assistance it could not use the system, at least for now. Earlier this month, another judge overturned that decision.
Meanwhile, Wendy Chavez, a regional coordinator and local director for Hickory's Home and Health Services office, says disabled people are hanging in the balance.
Nurses who work for the agency serve patients ranging from 5 years old to well into their 90s. Nine out of 10 of those patients would get 40 to 50 percent less time with a nursing assistant if the state's scoring system goes into effect, she said.
Excluding the severely disabled, patients can receive no more than 60 hours per month, or about 2.5 hours a day.
She points to a bed-bound patient who gets an hour and a half each day. It's all her nurse can do in that amount of time to lift her out of the bed and bathe her, Chavez said.
Chavez also talks about an elderly woman who was plagued by bedsores, falls and hospitalizations before she found in-home health care.
They wouldn't be able to stay home without personal care services, said Chavez, who thinks it's the patient's right to make that decision.
"The big picture is if you cut those services, you have families broken, people forced into nursing homes and other facilities," she said.
Deen disputes the notion that people who lose personal care help will automatically have to go into nursing homes that could cost Medicaid more in the long run than providing in-home assistance.
But he acknowledges the argument that Chavez and other advocates make: that people could get sicker and require nursing home services should they lose home health care.
Chavez understands the state's budget woes, too, she just can't agree with the way regulators are trying to fix it.
"We've got to protect (personal care services)," she said. "There's just no other option. We understand the budget looks rough, but taking services away from out frailest, our most vulnerable patients?"
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