According to a report in Politico Florida, more than 6,000 poor, disabled, or elderly Floridians who applied for home- and community-based services died during a 12-month period while they were on waiting lists for those services, state data shows.
According to statistics provided by the Department of Elder Affairs, 6,538 people died during the 2014-2015 fiscal year while they were on a waiting list for one of four programs aimed at keeping the elderly out of nursing homes: Medicaid managed long term care, “Home Care for the Elderly,” “Community Care for the Elderly,” and the Alzheimer’s Disease Initiative. [More details are provided about the numbers of deaths occurring among seniors’ waiting for places in Medicaid-funded elderly community of care programs in Florida, and later in this article, details are provided about the failure of the state of Texas to implement the Patient Protection a n d Affordable Care Act.]
POLITICO Florida did not have an easy time acquiring the data from the Department of Elder Affairs. State Representative Mark Pafford, a Democrat from West Palm Beach, asked House health care budget chief, Rep. Matt Hudson, for that information during a committee hearing. Hudson told Pafford that he did not have the data and that Pafford needed to request the information from the state, Politico reported. Hudson apparently continued to have no comment after Politico provided the data to him.
The data counts all deaths that occurred from July of 2014 through June, 2015, whether or not they are related to the reason a person was waiting for a program. Nearly 2,000 died while on the state’s Medicaid managed care long term care program. 4,590 were waiting for services from the other three programs. The average person on a waiting list is 80 years old.
Governor Rick Scott’s administration responded to Politico that it has increased funding more than $94.8 million since taking office, a move intended to reduce the number of elders on wait lists. Another $3.95 million is earmarked to be added to the effort during this fiscal year.
The AARP is also watching the situation. Politico Florida reported that the association often hears about it from its members, quoting AARP communications direct Dave Bruns as saying, “This is a tragedy for this to happen as often as it’s happening. Florida is falling further and further behind.” Bruns stressed that the AARP is grateful for the additional funding the Legislature has directed toward the programs, which added an additional 812 slots to the Home and Community Care for the Elderly program. “When you have wait lists growing by thousands and thousands every year then clearly we need a different approach,” Bruns said.
POLITICO Florida requested the total number of people on waitlists from the DOEA but did not receive that information at press time. However, information compiled by AARP indicated that there were 58,818 people on waiting lists for home and community based services as of December 2015. Bruns suggested those lists could grow as the Baby Boomer population continues to age.
The Politico report concluded with a quote from the AARP’s Brun. “We’ve only just begun to see the types of social changes that will be sweeping over Florida for the next 30 years. What are they going to do 30 years from now?”
Meanwhile, Texas appears to be on the cusp of tackling the same problem. According to an investigation by Christopher Cheney, reported by HealthLeaders Media, Texas “stands out among states unwilling to expand Medicaid programs in terms of the number of human lives and costs to healthcare providers.”
Cheney interviewed Vivian Ho, PhD, a professor of economics at Rice University and professor of medicine at Baylor School of Medicine in Houston. “There are at least a million lives at stake,” Dr. Ho told Cheney. “The people without insurance who can’t afford healthcare services is still alarmingly high.” Although several hundred thousand previously uninsured Texans gained coverage through the Affordable Care Act health insurances exchange — operated in Texas by the Federal Government — about 20 percent of the state’s 26 million people remain uninsured, Ho explained.
She is the co-author of two new reports about the affordability of healthcare services and health insurance in Texas. The first report, based on survey data, found that 14.7 percent fewer Texans had problems paying their medical bills in 2015 compared to 2013. The second report’s survey found that 69.1 percent of uninsured Texans cite high costs as the primary reason they do not have health insurance.
Dr. Ho concludes that, unless Texas lawmakers expand Medicaid under provisions of the PPACA, the modest gains will eventually be dwarfed by the growing number of low-income Texans without coverage. She pointed out that approximately one million adult Texans would be eligible for health coverage if the state participated in the PPACA’s Medicaid expansion program.
What is a serious situation now could grow worse. The federal government is preparing to implement deep cuts in the “Disproportional Share Hospital” program that has offset the cost of uncompensated care over the past two decades at hospitals across the country. In addition, the “Healthcare Transformation and Quality Improvement 1115 Waiver,” a 5-year Medicaid program that has given Texas about $29 billion in federal funding to offset uncompensated care and help providers pay for improvements in care delivery, is scheduled to expire in the fall, HealthLeaders reports.
Dr. Ho continued, “If the 1115 waiver is not renewed, emergency rooms across Texas could be overwhelmed by poor men and women who will have nowhere else to go to seek medical attention when they need it.”
This scenario is not limited to Texas, reporter Cheney was told by Katherine Hempstead, health insurance program director at the Princeton, NJ-based Robert Wood Johnson Foundation:
“Texas is a little bit unique because it has a very high uninsured rate, so it has a lot of uncompensated care covered in its current Medicaid waiver. Florida is in a similar boat… But while Texas and Florida may be somewhat unique in terms of their size and their very high uninsured rates, hospitals in all states that have not yet expanded Medicaid are experiencing considerable fiscal stress.
In many of these states, hospital associations are leading expansion efforts and in many cases are willing to pay the state share through some kind of provider fee. Widespread financial distress and sometimes closings of hospitals in non-expansion states is another way to bring the message to politicians and the general public that failure to expand Medicaid can affect everyone’s access to healthcare.”
As of January, 31 states and the District of Columbia had expanded their Medicaid programs through provisions or waivers of the PPACA. HealthLeaders stated that the status of the struggle over Medicaid expansion in the remaining 19 battleground states continues.
©2016 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan’s Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com
