The Department of Health and Human Services has to be my favorite part of state government – it’s the perfect blend of bungling, chicanery and politics all built on a foundation of good intentions.
Over the past year Secretary Lanier Cansler – who’s sort of a combination of Fagan and Houdini – has been telling legislators that somewhere between 45% and 85% (the number seems to grow every time Cansler speaks) of the Medicaid Home Care patients are chiselers and if he cuts their care he’ll save taxpayers millions.
Next, Cansler parlayed all that talk of fraud and savings into a deal with legislators that allowed him to pass out a $25 million no bid contract to one of his former clients (from back in the days when he was a lobbyist).
But, a year later, after pouring millions into studies and reviews and computer programs it doesn’t look like Cansler’s cut a single chiseler.
Now, those are examples of bungling and chicanery. Here’s where politics comes in.
Since no one’s been cut some folks are beginning to wonder if Cansler’s numbers are any more reliable than, say, President Obama’s projections of how many jobs his ‘Stimulus Plans’ would create and if his goal all along wasn’t to get that no bid contract past legislators.
Plus, money’s tight and some legislators are getting fidgety because Cansler’s department’s spending is going up not down like he promised.
So Cansler’s in a bit of a fix. But he’s come up with a solution. He’s gone over to the legislature and said he needs to change the definition of who is sick – which, explained simply, means he’s rewriting the rules to make fewer patients eligible for care. Which means he can deliver the cuts he promised. Which means, hopefully, legislators will stop asking him pesky questions.
But if, as Cansler claims, 85% of the patients are chiselers who aren’t eligible (or who are getting care they don’t need) now – why on earth does he need to change the rules (to make fewer patients eligible) to deliver the cuts he promised?
Anyway, Cansler baited the hook, dropped it in the water and Democratic legislators bit. Which gets Cansler out of one mess but brings us back to bungling.
Because Cansler ignored a key fact.
There are three levels of care for elderly and handicapped patients on Medicaid.
There is ‘In Home Care’ – where people stay in their homes and nurses’ aides come to help them for an hour or two a day, which is the least expensive form of care.
The other two levels are what’s called ‘institutional’ care.
The first are Adult Care Homes – which are what most of us think of as ‘Nursing Homes’ but aren’t; they provide care to patients in institutions whose infirmities are, comparably, less severe. Adult Care Homes are the next step up the ladder from In Home Care and, naturally, cost more than Home Care.
And, finally, there is full-fledged Nursing Home Care – for folks who need a lot of care which, of course, is a lot more expensive than either Home Care or Adult Home Care.
Now when Cansler cuts care to 22,000 In Home Care patients on the bottom rung of the Medicaid latter what happens?
The answer is some of those patients – who won’t be able to stay at home without care – will move up the ladder into Adult Care Homes. How can that be? Because, oddly, under North Carolina law it is easier for a patient to get into an Adult Care Home than it is to qualify for less expensive In Home Care.
Bottom line: Cansler promised legislators his latest plan is going to save $45 million. But if, say, half of the In Home Care patients he’s cutting move up the ladder to Adult Care Homes it’s going to cost the state $91 million; plus it’s going to cost the counties (who help pay for Adult Care Homes) a matching $91million – so to save taxpayers $45 million in one program Cansler may cost taxpayers $182 million in another, which brings us back to politics.
Because, at least, Cansler will have gotten himself off the hook and no pesky legislators will be asking, Why haven’t you cut those chiselers you keep telling us about?
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