Alternate options to nursing houses get $12B increase in COVID invoice

WASHINGTON (AP) – Recalling the aftermath of the pandemic in nursing homes, the COVID-19 Relief Act offers states a generous boost in funding for home and community care as an alternative to institutionalizing the disabled.

Proponents hope the estimated $ 12.7 billion will accelerate the steady shift to support the elderly and disabled and their overwhelmed families in everyday life. However, the money for government Medicaid programs will only be available for four calendar quarters this year and next. This raises concerns that it will have only fleeting effects and calls for permanent legislation.

“What we really want is that when our loved ones need support, we will be able to get that support without another fight,” said Maura Sullivan of Lexington, Massachusetts, who has two sons with autism. “We don’t want our kids cut out just because the potholes in the states need to be fixed.”

Sullivan, a lawyer for the disabled in her state, has an older son, Neil, with severe autism who is in a residential complex. But she believes that her younger son Tyler, now 17, could one day hold a job if he had help. Autism is a developmental disorder that leads to social, communication, and behavioral disorders. There are a range of severity levels, and while some people with autism need a lot of help with the day-to-day basics, others are intellectually gifted.

Medicaid was originally intended as a health program for the poor and the severely disabled in the states. Since it has grown to around 1 in 5 Americans, it’s also the standard long-term care program in the country, though qualifying is often a tedious process.

While the federal government mandates government Medicaid nursing home care programs for low-income people, home and community support services do not. All states offer such services voluntarily, but the scope varies widely. Home and community care typically costs less than half that of institutional care, although there is some debate as to whether it prevents or just delays people from going to a nursing home.

The coronavirus pandemic has highlighted the vulnerability of nursing home residents. Only about 1% of the US population lives in long-term care facilities, but they were responsible for about a third of COVID-19 deaths in early March, according to the COVID Tracking Project.

“COVID has clearly shown that living in an institution carries a higher risk of infection and death,” said Martha Roherty, executive director of Advancing States, which represents government agencies on aging and disability. “If we want senior citizens and people with disabilities to have a higher quality of life, that will not be in a care facility.”

A survey by the Associated Press-NORC Center for Public Affairs last year found that 60% of Americans would be very concerned if an aging friend or family member needed long-term care in a nursing home during the pandemic, and another 27% would be moderately concerned.

The billions in the COVID-19 bill represent the first new federal money for domestic and community services since the Obama-era Affordable Care Act more than 10 years ago, said MaryBeth Musumeci of the bipartisan Kaiser Family Foundation.

“I anticipate this will be the first step in adding additional focus on empowering Medicaid’s home and community-based services and figuring out how to help states serve more people in the community,” said Musumeci , Expert on Medicaid and the disabled.

In Congress, Rep. Debbie Dingell, D-Mich. And other Democratic lawmakers recently tabled legislative proposals to make such services a mandatory Medicaid benefit and set basic standards and requirements.

“There are so many people who are forced to go to institutions as they age,” Dingell said. “People shouldn’t have to go to long-term care facilities where they are at higher risk of disease and more isolated.”

The chairman of the House Committee that oversees Medicaid, Rep. Frank Pallone, DN.J., says reforming long-term care, including expanding access to home and community care options, is “my number one priority.”

States are likely to crack down on federal efforts to create a new mandatory Medicaid benefit. There is also some skepticism about the money in the COVID-19 relief bill, if it means states would keep their pockets when the federal temporary funding ends.

“This country needs and deserves well-designed, humane long-term care policies, and the foundation for that must be access to these services from anywhere except Medicaid,” said Matt Salo, executive director of the National Association of Medicaid Directors, of Dingell’s proposed legislation.

Currently, states and disabled attorneys are awaiting guidance from the federal Medicare and Medicaid Services Centers on how to spend the money on the COVID-19 bill. The agency said it was coming soon. Examples of possible applications are reducing waiting lists, increasing the pay of support staff, or investing in technology to improve service delivery.

Sullivan, the Massachusetts mother whose two sons have autism, said they were both at home for much of the pandemic year. She campaigns for her state chapter of The Arc, a nonprofit that advocates for people with intellectual and developmental disabilities.

Although her older son, Neil, has since returned to his apartment building, Sullivan said it was harmful for younger son, Tyler, to be cut off from other people.

“The isolation was really bad; He was at a point in his development where social connections really became important, ”she said. “Honestly, we’ve seen a regression this year and we want to bring him back to where he was with improved services and support.”

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