Ten thousand down, but 28,000 more to go.
Louisianans with disabilities and their families received great news last week when the state Department of Health announced it had cleared some 10,000 petitioners off waiting lists for waiver program services. For people meeting certain financial tests who have intellectual or physical difficulties, these services pay for assistance with life activities and, if needed, medical help.
When this alternative to the past practice of warehousing those with disabilities in nursing homes became available in the state about two decades ago, people applied to one among several programs that overlapped somewhat, making for disparate, uncoordinated lists. The state doled out services not on the basis of severity of need or resources available from all programs, but on who had been on that list the longest.
The inflexible system didn’t consider when somebody’s needs changed that made the original list placement obsolete. Urgency of need wasn't factored in, either, except for emergency requests. Many of those asking for services waited a decade or more; some died while waiting.
That has changed for those with less complex or intense but relatively immediate needs, as LDH now places all applicants on a single list and rates the needs of each potential client, letting officials steer resources to all needing supports currently or within the next year. While a waiting list remains, unlike the previous versions, it now contains nobody not receiving at least some help for an immediate need.
Thankfully, Gov. John Bel Edwards completed this effort that began under former Gov. Bobby Jindal. But tinkering with program administration goes only so far.
These changes haven’t helped provide all necessary assistance to 28,000 people with more complex and intense needs, who continue to languish on the registry because the state lacks money. While in this year’s legislative sessions lawmakers found dollars to pry open 600 more slots, obviously that represents a drop in the bucket.
Money to wipe out the list shouldn’t have to come from higher taxes or beggaring other priorities. Instead, changing policies concerning Medicaid and closer scrutiny of its spending can make the difference.
Moving waiver recipients to managed care would save $200 million annually. This would complement LDH’s stated goal of moving people out of more expensive nursing home care and into the community at reduced cost. Although Edwards supported this as a gubernatorial candidate, he has refused to move forward on it.
By contrast, when he expanded Medicaid, that triggered tax increases on insurance policies and some hospital stays, which were then passed on to consumers and taxpayers. Redirecting these dollars to fund waiver services and asking able-bodied adults on Medicaid to make small payments when they access care redresses the imbalance of fulfilling the wants of the able-bodied before the needs of people with disabilities.
The Legislative Auditor also has identified wasteful Medicaid spending that could save nearly $500 million annually. The waste is connected to enrolled individuals whose tax returns indicate much higher incomes than they marked on their applications, which would likely render them ineligible for assistance. Additionally, the Legislative Auditor has faulted LDH for lax monitoring of providers that could cost hundreds of millions of dollars each year.
Assuming that unmet services for waiting list members total half of the typical money spent yearly per recipient for the most expensive waiver, to clear the registry would cost an additional $728 million a year. These policy changes and tighter program enforcement could fund what's needed.
An Edwards signature ordering managed care, another requesting that the federal government approve cost-sharing by Medicaid patients, one on legislation diverting tax dollars, and a determination to cut out waste can eliminate the waiting list entirely a year from now.
Jeff Sadow is an associate professor of political science at Louisiana State University-Shreveport, where he teaches Louisiana government. He is author of a blog about Louisiana politics at www.between-lines.com. When the Louisiana Legislature is in session, he writes about it at www.laleglog.com. Follow him on Twitter, @jsadowadvocate or email firstname.lastname@example.org. His views do not necessarily express those of his employer.