Rep. Chapelle-Nadal wants to expand eligibility for in-home care

Governor Matt Blunt's State of the State call to increase in-home care funding by $53 million opened the door, now Rep. Maria Chappelle-Nadal wants to bring 'em in.

Chappelle-Nadal wants to see the availability of in-home care to seniors and the disabled expanded. She cites the better health outcomes and quality-of-life issues that in-home care can provide, if it's available. Her plan focuses on those who fall in the grey middle; just outside the eligibility requirements, but without the assets to provide it themselves.

To do so, Chappelle-Nadal proposes to increase the amount of non-exempt cash assets an individual or couple is allowed to have and still qualify for in-home care. Currently the limit is $1,000 for an individual and $2,000 for a couple. Chappelle-Nadal doesn't specify an increased figure.

A second step would increase the individual income eligibility level to 300% of the poverty level. The current cut-off is just over the individual poverty level, or $12,636.

"As an advocate for seniors and the disabled, I plan to introduce legislation that will address the eligibility guidelines for in-home care. This bill is progressive and will aid in planning for our population’s future." said Chappelle-Nadal in a letter to constituents.

Read the complete letter after the jump.

Dear Friends and Neighbors,

In my State of the State response last month, I applauded Governor Blunt’s plan to expand in-home care. This is a vital issue to me and a wonderful opportunity for those who need these services. In-home care, also called home and community-based services, allows senior citizens and disabled individuals to stay at home as long as possible, in lieu of, an institutional setting. These individuals are independent longer and they typically have better health outcomes. The cost of nursing home care or institutional care is also more expensive than in-home care. Currently, the Department of Health and Senior Services administers in-home care through the Medicaid program for those that are eligible.

Today, over two-thirds of Missouri’s Medicaid dollars are spent on the care of seniors and the disabled, even though they represent only one-third of the state’s Medicaid recipients. This disproportionate share is due, in large part, to the heavy reliance on high cost of nursing home care. In 2000, the number of individuals aged 65 and older was 34.8 million, or 12.7% of the nation’s population. At the same time, 13.5% of Missouri’s population was aged 65 and older. By 2020, it is estimated that persons aged 65 and older will compose 16.5% of the population nationally and 18.2% of Missouri’s population. These statistics are very important because they show that our aged population is growing. Not only are in-home care services needed to curb the high cost of nursing home care, but they are also needed because of the sheer numbers of the growing senior citizen population.

Governor Blunt, in his State of the State address, remarked that if his budget were approved in-home care funding would be increased by 53 million dollars. What this 53 million dollars will do is not yet certain.

In 2006, the Governor directed the executive agencies (Departments of Social Services, Health and Senior Services, and Mental Health) to study the Missouri Medicaid Reform Commission’s recommendations for changing Medicaid. The executive agencies were charged with making recommendations that would aid in the transformation of the Missouri Medicaid Program into the Governor’s proposed MO HealthNet. The executive agencies’ recommendations concerning in-home care are found in what is called the Transformation Report. These recommendations are worth noting because they may foreshadow what the Governor proposes to do with this 53 million dollars.

A few of the suggestions are:

A single point of entry is needed to make sure individuals are aware of existing services and resources available to help them stay in their homes. This single point of entry system should be designed to be user-friendly and provide current information and assistance.
The personal care program should be redesigned to reduce the administrative burden, improve quality and establish consistent care planning based on an individual’s needs.
The Aged and Disabled Waiver and the Independent Living Waiver should be redesigned to reduce the institutional bias. The services offered should be expanded to allow individuals to stay in their communities longer, reducing the need for nursing home care.

I agree with the Transformation Report that additional services should be offered to in-home care recipients, that plans of care should be individualized, and that the process should be straightforward and streamlined. The aspect that’s missing here is expanding eligibility. With an aging population and a growing number of individuals living with debilitating conditions, it’s important to recognize the growing need for in-home care services.

As an advocate for seniors and the disabled, I plan to introduce legislation that will address the eligibility guidelines for in-home care. This bill is progressive and will aid in planning for our population’s future. To expand eligibility, I want to increase the cash asset level that an individual can have to qualify for Medicaid. Right now, an individual can only have up to $1,000 in non-exempt assets to qualify for Medicaid’s in-home care services. A couple can only have $2,000 to qualify. Exempt assets include the home that the individual lives in, one automobile, household goods. Non-exempt assets include cash, savings, stocks, life insurance, and other property. This is a very small amount of assets. A disabled individual is forced to spend all of her cash, securities, and sell any other property besides her home until she reaches $1,000.

I also want to allow an individual with an income up to 300% of the federal poverty level to qualify for home and community based services. Three hundred percent of the federal poverty level may sound like a lot, but when the federal poverty level is already at utter destitution levels, 300% is not that much money. Today, an individual is considered in poverty if her income is $10,210. A couple is considered in poverty if their combined income is $13,690. Under the current eligibility guidelines for home and community based services (people aged 63 and older only), individuals can make no more than $1,053 per month. This is $12,636 per year. Under my proposal, an individual could make $30,630 a year and still qualify.

It is imperative that we plan for every Missourian’s future in order to let each individual prosper, no matter their age or disability.

As always, please feel free to contact me with any questions or concerns you have.

To learn more about current Medicaid eligibility guidelines for the elderly and disabled, please visit: HYPERLINK "http://www.dss.mo.gov/fsd/massist.htm" http://www.dss.mo.gov/fsd/massist.htm