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Using Medicaid dollars to expand long-term care choices in Michigan

December 10, 2014 at 6:25 PM EDT
Most Medicaid funds for long-term care go to nursing homes, but waiver programs give low-income seniors and younger adults with disabilities alternative options to get care in more home-like settings. The NewsHour's Cat Wise reports on a program in Michigan called MI Choice, which aims to empower participants and their families to make decisions about the services they want.
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JUDY WOODRUFF: Next: an effort in Michigan to permit frail senior citizens and adults with physical disabilities to remain living in their homes with the help of supportive services.

It’s being done through a special Medicaid waiver available in all fifty states. About 800,000 people around the country are now in similar programs.

The “NewsHour”‘s Cat Wise has our report.

CAT WISE: Making a pot of coffee is a morning ritual 77-year-old Dorothy Sites relishes. But until just a few months ago, Sites didn’t have a coffee pot or her own kitchen. That is because she was living in a nursing home after suffering a stroke four years ago.

DOROTHY SITES: In the nursing home, you never got out of your chair unless it was to bathe or go to the bathroom. And here I can ask for privacy and get it.

CAT WISE: The “here” she is talking about is a one-bedroom, one-bath apartment in the American House assisted living facility outside Detroit, Michigan. Sites moved in with the help of a state program called MI Choice. That’s M.I. for Michigan.

It’s funded through a special federal Medicaid waiver that’s offered in all 50 states, though benefits vary from state to state. Traditionally, most Medicaid long-term care dollars have gone to nursing homes. But states are increasingly using waiver programs to provide supportive services for frail, low-income seniors and younger adults with disabilities who prefer more home-like settings.

WOMAN: Housekeeping.

DOROTHY SITES: Come on.

WOMAN: Hi, Dorothy.

DOROTHY SITES: Hi there.

WOMAN: Good morning.

DOROTHY SITES: How are you?

WOMAN: It’s your cleaning day.

CAT WISE: Sites now gets weekly housekeeping and laundry services, and daily help with personal care, medication reminders, and meals as part of the 18 home services offered to MI Choice participants.

She herself pays for utilities and a subsidized rate for rent.

LYNN BULLOCK: How’s your coffee?

CAT WISE: Sites’ daughter, Lynn Bullock, says despite being initially skeptical that her mom could live on her own again, she’s pleased with how its gone so far.

LYNN BULLOCK: At first, I thought maybe it would be difficult, but, as she has been here, she is actually doing better because her mood is better.

CAT WISE: Michigan’s waiver program, which has been around for more than two decades, serves about 14,000 mostly seniors. In recent years, Michigan has been making a big push to reduce the number of those living in nursing homes. Many seniors want out, and the state wants to save money.

MARY ABLAN, Area Agencies on Aging Association of Michigan: Do you think you would like to stay or do you think you would like to move on to a less restrictive setting?

MAN: Probably move on.

CAT WISE: According to state figures, Michigan’s Medicaid nursing home care costs about $180 a day, compared to about $75 a day for MI Choice recipients.

MARY ABLAN: We have transitioned over 10,000 people from a nursing home back to the community.

CAT WISE: Mary Ablan heads up an association of Michigan nonprofits that administer MI Choice. She says one of the goals of the program is to let participants and their families make decisions about the services they want. This approach, which is gaining traction around the country, is called person-centered care. And, in Michigan, the key to that effort are liaisons called care coordinators.

MARY ABLAN: They’re the nurses and social workers that are working with the participants and working with the family members, and to make sure that the participant gets what he or she needs, but even goes beyond that, to making sure that they have a life. That’s another element of person-centered care is not just meeting people’s physical needs, but to make sure that they’re living the life that they want to live.

CAT WISE: One of those care coordinators on the front lines is Deb Shtulman, who manages services for 45 MI Choice recipients in Detroit’s northwestern suburbs.

CHARLENE GORDON: Hi, Deb.

DEB SHTULMAN, MI Choice Care Coordinator: Hey, how are you?

CHARLENE GORDON: I’m good. How are you?

CAT WISE: On a recent afternoon, Shtulman visited the home of Charlene Gordon, who has been taking care of her mom, Lucille Morris (ph), for about 10 years with the help of services provided by MI Choice. Morris, who is 78, had a stroke more than 20 years ago, when she was a founder and CEO of a company that made parts for Detroit carmakers.

Today, Morris is getting 43 hours a week of care from health aides. During her visits, Shtulman tries to gauge if Morris is getting the care she wants.

DEB SHTULMAN: Is Charlene preparing meals for you?

WOMAN: Yes.

DEB SHTULMAN: And you’re helping too right?

CAT WISE: While Shtulman aims to provide the care that her clients want, she also must juggle funding limitations.

DEB SHTULMAN: These are Medicaid dollars that we’re spending. And we try and help families think of creative ways that they might be able to meet a need, rather than us giving them more hours.

CAT WISE: Studies show that most seniors want to remain in their homes as they age, but home care is not a Medicaid entitlement, and waiver programs are not funded enough to offer around-the-clock intensive care that some need in later years.

That can be a problem, says Howard Gleckman, a senior fellow at the Urban Institute.

HOWARD GLECKMAN, Urban Institute: States can have a program that looks very good on paper, but maybe it provides only two of three hours of home care a day. For many people, that may just not be enough.

CAT WISE: Gleckman also says the states are limited in the numbers who can be served.

HOWARD GLECKMAN: The only way states avoid paying too much for these programs is they have long waiting lists. In some states, the waiting lists are two or three years, so chances are very good you are going to be dead before you get to the top of the list.

CAT WISE: In fact, in Michigan, about 4,500 individuals are currently on the MI Choice waiting list, including the 90-year-old mother of Joan Barrett, a high school chemistry teacher in Troy.

JOAN BARRETT: This is a picture board we did for my mom’s 90th birthday party.

CAT WISE: Barrett’s mom, also named Joan Barrett, has been on the waiting list for eight months. She currently pays $5,000 a month for an assisted living apartment, but Barrett says her mom’s savings are about to run out, and she and her seven siblings are concerned they will have to move her to a nursing home early next year, unless she gets accepted into MI Choice.

JOAN BARRETT: I get very discouraged and very concerned. We have tried to figure out how we can keep her at the place she’s at. My one sister is taking money out of her 401(k) in order to try to stretch her time a little bit longer.

CAT WISE: Earlier this year, Michigan’s governor, Rick Snyder, pushed the state legislature to pass $25 million in new funding for MI Choice.

GOV. RICK SNYDER, (R) Michigan: Let’s make Michigan that no-wait state.

(APPLAUSE)

CAT WISE: Advocates are hopeful that means an additional 1,800 people on the wait list could be enrolled over the next year.

Cat Wise for the “PBS NewsHour” in Michigan.

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