Senator Doug Berger's Blooper

Carter Wrenn posted on June 08, 2009 18:26

For the past month, State Senator Doug Berger has been telling just about anyone who’ll listen that 45% of the patients who get home care services through Medicaid are ineligible.

He’s gotten so worked up over the whole thing he wrote one lady, who disagreed with him, and told her the ‘ineligible’ patients’ children ought to be supporting their families – just like he supports his mother-in-law, adding: “Our family would like would like the luxury of someone helping us cook her meals and help keep our house clean” too.

Anyhow, Senator Berger got so exercised he rolled legislation out of his Senate Committee to cut the Medicaid budget for home health care a whooping 60%.

Then the whole thing started to come apart on him at the seams.

The Association for Home and Hospice Care of North Carolina wrote the Department of Health and Human Services and asked for a copy of the study Berger claims says that 45% of their members’ patients are ineligible for home care services. They got nothing. Zip. Zero. Nothing. Then they threatened to sue and got an eye full – the study popped out of HHS and, lo and behold, it didn’t say what Berger claimed.

Senator Berger had said the study – by a state vender – analyzed a cross section of Medicaid patients. It didn’t. The focus was on paperwork and agencies that were out of compliance with paperwork requirements.

What about the claim 45% of the patients are ineligible? Dead wrong. Because the vendor’s preliminary patient reviews were reversed most of the time through a more in-depth review approved by HHS. HHS discovered ineligible patients weren’t ineligible at all.

For instance, a home care agency in western North Carolina had 10 of its 10 patients ruled ineligible by the contractor. Every one was reversed by HHS. Another agency had 7 of 10 patients ruled ineligible. Again, every one was reversed by HHS. A nurse with a third agency, again in western North Carolina, described how the contractor conducted the study: They “found that 85% of our patients did not qualify. One of these patients was a 90 year old blind man who could not bath, ambulate or toilet himself.” HHS decided every one of that agency’s patients were qualified too.

HHS made public detailed data for one month – January 2008. 70% of patients the contractor said were ineligible a year and a half ago are still receiving care today – with HHS approval. (The remaining patients either died, moved into a nursing home or moved off Medicaid – HHS can’t say which.)

So how did Senator Berger commit such a blooper? Did he just get bad information from HHS Secretary Lanier Cansler, then whip a bill out of his committee that cut 36,000 disabled patients’ home care?

Even worse, consider this: When Berger finishes cutting 36,000 patients home care a lot of them are going to be left with only one choice -- to go into rest homes and nursing homes. Let’s say 60% – the same number Berger cuts – do just that. The cost to the state of caring for a patient in home care is $9000 a year. In a rest home or a nursing home the cost is from $21,000 to $48,000. Do the math. That mistake could cost taxpayers almost a billion dollars a year.

Last week at their caucus, according to one legislator, House Democrats threw open the flood gates to increase taxes between $1-2 billion to balance the budget – but unless someone corrects Senator Berger’s mistake a good part of those taxes are going to pay for ‘Berger’s blooper.’

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