Medicaid
Medicaid provides healthcare to Missourians who are low-income, people with disabilities and seniors. Specific services include prescription drugs, long term care, therapies or durable medical equipment. Individuals with disabilities on Supplemental Security Income (SSI) earn only $552 a month, which is 72% of the federal poverty level. People receiving Social Security Disability Insurance (SSDI) receive higher payments based on their work history, but on average they remain right around the poverty level. (The 2003 federal poverty level for an individual is $8,980 a year.) There is no way that people with disabilities and seniors living at or below poverty would be able to afford any of these services without Medicaid coverage.
The cuts to the spend down program, over-the-counter medications and supplies, durable medical equipment rates and General Relief have impacted thousands of people with disabilities and seniors. These cuts and others have caused there to be about 100,000 more uninsured individuals in Missouri. Additional cuts to Medicaid compound the health care problems of our citizens and increase costs to the state due to lost economic activity associated with health care spending and increased uncompensated care.
Medicaid Priorities for People with Disabilities
Home and Community-Based Services
In the 1999 Olmstead v. L.C. and E.W. decision, the Supreme Court ruled that states are required under the Americans with Disabilities Act to provide services in the "most integrated setting" and that isolating people with disabilities in institutions is discrimination. As the major funding source for long term services, the Medicaid program is essential to Olmstead implementation. Medicaid State Plan services such as personal assistance services and Medicaid Home and Community-Based Services Waivers must be available to people with disabilities and families in order to transition people out of institutions and keep people in their own homes and communities.
The Consumer-Directed Personal Assistance Services (CD-PAS) program is a necessary home and community-based service in the Medicaid State Plan. The CD-PAS program is a de-institutionalization program designed to give people with disabilities the level of service and supports they need to stay out of the nursing homes. Not only does CD-PAS increase quality of life and give people their rights under the Americans with Disabilities Act, the program also has a positive impact on Missouri's economy.
- The total Medicaid appropriation for CD-PAS is $68 million. The $27.2 million of state dollars brings in a federal match of $40.8 million. Federal funds stimulate economic growth because new dollars are brought into the state economy.
- Missouri's Medicaid "multiplier effect" is 3.46 for every $1 of Medicaid spending. Medicaid dollars trigger earnings and purchases as they circulate through the state economy (Families USA, January 2003). This means that statewide, the CD-PAS program leads to $235 million in new business activity.
- Recent studies show that the CD-PAS program increases quality of life and decreases other Medicaid expenditures. One research project studied 578 individuals one year before they enrolled in the CD-PAS program and one year after. They found that in-patient hospitalization costs decreased by almost 60%. Receiving quality personal assistance helps reduce the costs of hospitalization and other health care emergencies.
- The CD-PAS program is more cost-effective than nursing home placement. As of June 2003, the CD-PAS program equaled 47% the cost of nursing home placement. This saves the state almost $16,000 per person a year. Without the CD-PAS program, many people would be unnecessarily placed in nursing homes.
- Medicaid could become more cost-effective if individuals who can live in the community were transitioned out of nursing homes.
- In 2001, 43% of Missouri nursing homes residents had NO Activities of Daily Living impairments. This means that they do not need any assistance with activities of daily living such as getting out of bed, bathing, dressing, eating, shopping, housekeeping, etc. People with no impairments do not need to be in nursing homes where the state is spending about $30,000 per person annually. (Center for Medicare and Medicaid Services[CMS], Nursing Home Data Compendium 2001)
- In 2001, 42.3% of Missouri nursing home residents had No or Very Mild cognitive impairment. These individuals could easily live in their own homes and communities for much less than is being spent on them in the nursing home.(CMS)
- The occupancy rate for Missouri nursing homes was 88.2% in 2001.(CMS) The nursing home industry is overbuilt in Missouri. Unused beds should be eliminated.
