I am writing in regard to recent articles appearing in your paper following the state Department of Health and Hospitals decision not to move forward with its plans to implement managed care for those persons receiving Medicaid Long-Term Care Services. Long-term services may be provided by nursing facilities, home- and community-based waiver providers, group homes and personal care attendant agencies to folks who are unable to care for themselves because of physical, mental or intellectual disabilities. I support the administration’s position for a variety of reasons.
Few other states have proposed to move their entire long-term care population into managed care without at least conducting a pilot to make sure the programs do not disrupt the care of patients, produce better health outcomes and actually save money. Unfortunately, the input from stakeholder groups led to a decision to put the roughly 50,000 Louisiana residents receiving these services into managed care without taking into account the complexities involved for this needy population. Most articles have featured comments from taxpayer-funded advocacy groups that anticipate managed care will lower the nursing home population and any savings realized would be reinvested in home- and community-based services. History shows that will not be the case.
For those persons needing 24-hour care, nursing facilities not only provide quality care, they are the most cost-effective option for state taxpayers. Our patients are required to pay a significant portion of their income to help pay for their care, and our facilities pay a fee to help pay the state’s share of the payments we receive from Medicaid. In our facilities, the average Medicaid rate is set at approximately $7 per hour, while payments to community-based options generally exceed $11 per hour. They are not required to collect a copay, pay a provider fee or provide services such as durable medical equipment, transportation, over-the-counter medications or food services that are included in the rate paid to nursing facilities.
The Long-Term Personal Care Services program continues to be problematic, as it is plagued by fraudulent activity and complaints of abuse and neglect.
Editorials and advocacy letters never fail to point out that there are substantial waiting lists for many of the waiver programs. The public is never informed that many of the people on these waiting lists are receiving other services provided by Medicaid. It is my belief that managed care will never produce any real savings. After all, they are in business to make money just like every other business. As the system now works in Louisiana, managed care is simply another level of bureaucracy dictating how health care services will be provided and who will receive them.