Louisiana never has been good at making good health care spending choices with public money. The first signs that this may be changing perhaps are appearing.
For decades the prevailing philosophy was to take anybody considered low income with more than a mild long-term disability (through misfortune or aged infirmity) and to warehouse them in institutions either run by the state or private sector. The lobby that built up around nursing homes to keep the gravy train rolling eventually would exacerbate this trend and send costs (compared to other states on a per capita basis) sky high and force many who could have remained productive citizens in the community into shut-in situations.
But the backlash finally came through the Barthelemy case (which technically remains active since a settlement is being played out) where the state agreed it was not doing enough to provide elderly and disabled care in the least restrictive environment. This brought forth a Medicaid waiver program that would pay for home- and community-based care – but with an important indicator that it should do so only where the expense would be reduced as compared to institutionalization.
Unfortunately, spiraling costs of the state’s Elderly and Disabled waiver are casting doubt on the program’s effectiveness as well as stressing taxpayers. Fortunately, a solution is at hand.
The major flaw in the program is that from the start it has been first-come, first-serve. If one met a certain level of disability, one qualified, with no distinctions made in degree of disability. Further, when entering the waiting list (which has never come into the 90-day target of the settlement and in fact now stretches for years) it’s strictly done on chronological basis. Therefore, you have some people with severe disability waiting for years to get any services, while there are other only mildly disabled who have had services for years, and others like that who will get them prior to those worse off.
This makes no sense and a major change floating around the state’s Department of Health and Hospitals is to adjust service levels to the degree of disability and to create priorities on the waiting list along the same criterion. If implemented, these changes will send dollars where they really are needed and better accomplish the original goal of the program.
(It should be noted that this program is a Medicaid waiver, meaning to qualify the household must be near the poverty level. State policy for the infirm and disabled for those households lower middle class and above in income and/or assets is simple if immoral – they get no help from this kind of program. Or, to be more blunt, if you are poor, you get everything paid for, and if you’re not, you are to spend away all your assets in the care of the disabled person until you then become poor and qualify, or you detach that person from the family – often by divorce and breaking up a family – to put him or her into poverty and thus qualifying. The incredible inanity of this is another matter ripe for reform.)
By the end of September these reforms should be rolled out, to the relief of the truly needy disabled and taxpayers.
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