This week has been trying. I have a flood of emotions I’m trying to contain and I feel that I’m spinning around in circles. I try to be careful about what I say, but honestly, I’m not doing anyone any justice by putting a positive spin on it….if that’s even possible. This is my first blog post for NEILS and quite frankly, these are going to be very candid and unrehearsed blogs. They aren’t necessarily meant to incite debates, but rather help clear my head, help people understand various aspects of our organization, the disability community, some of the obstacles we have, and our true successes and achievements.
Our new Governor released his budget proposal for next year. To say I’m shocked is an understatement. Maybe I should have seen this coming, but anyone in the nonprofit world generally wants to think only positive thoughts. I’m struggling to find anything positive this time.
We didn’t get hit with just one cut, not even two cuts, but three major blows. This isn’t just to our organization, this isn’t just to other similar organizations, but I whole-heartedly feel like this is an attack on our aging and disabled populations. I’m angry and frustrated as are so many others. I feel like Missouri was moving in the right direction to improve the lives of people with disabilities and provide for equitable treatment and opportunities. Again, there goes my positive thinking again… We just took a major step backwards; actually I think we might have fallen into a crater on another planet. I’m not poking fun by any means; this situation is anything but humorous. Let me explain…
Let’s begin with the 3% decrease to the Home and Community Based provider reimbursement rates. Everyone is certainly welcome to their own opinion, but NEILS is a non-profit organization so we aren’t in the business to “profit” off the reimbursement rates. What monies we receive pays very competitive wages to home care attendants, provides additional programs and services (that are pretty awesome and unique in my opinion), and helps us keep our lights on. This decrease, for us, jeopardizes some of our program and services that have truly helped individuals with disabilities increase their independence.
More importantly though, the other two changes/cuts much more directly affect a good portion of our consumers. The Governor wants to lower the amount of services any one person can receive. To put it in perspective, he wants to lower the maximum amount of services by 40%. While for some that doesn’t seem like a lot, the reality is, some individuals who receive home care services and need a lot of assistance, will lose nearly half of their care. One can only hope these individuals have a great family support system that can make up for that 40% loss, but the reality is, most of our consumers wouldn’t need home care services if that support system was in place. That’s not meant to be a jab at the families, but with busy lives, family living out of state, etc. it’s the true reality for many people. So what if they don’t have that support system in place? What happens then? Well…that’s yet to be determined. For some it may mean many more hospital and emergency room visits due to injury, skin breakdowns, etc. For others, it may be they will be forced to move into a nursing home which is certainly more costly and the individual’s quality of life generally decreases, sometimes significantly. Some individuals, however, may not even qualify to move into a nursing home because they don’t meet level of care, which I’ll explain in the next paragraph. So what happens then?
The 3rd major change proposed by the Governor raises the eligibility level to receive home and community based services. This change will also raise the nursing home eligibility level by an equal amount. To be eligible for home care services and nursing home placement, participants must meet a minimum level of eligibility. Currently the level is 21 points, but that level may be increased to 27 points. Assessments are scored in increments of three (i.e. 21, 24, 27, 30, etc.) and are determined by the state for home care services. Raising the eligibility level means that individuals scoring less than 27 points will 1) lose their home care services and their eligibility to enter a nursing home, 2) be forced out of nursing homes with nowhere to go and no funding to help, and 3) lose their Medicaid-funded home-delivered meals.
I can certainly respect that balancing the state budget is an incredibly difficult process, but major changes such as these impact far more than what I’ve shared. We’ve identified 22% of our consumers who will lose their Consumer-Directed (CDS) home care services, 18% of our consumers who will lose their In-Home services, and 13% will receive a reduction in the amount of home care they receive. Our staff spoke with one area nursing home that indicated they believe approximately 75% of their residents will be displaced. I also spoke with one of our area senior nutrition centers who indicate their budget cuts will also have a huge impact on the nutrition services they are able to provide. The economic impact is massive too. We estimate that approximately 50 home care attendants who provide care to our consumers will lose their employment through the CDS program alone and we’re just one of hundreds of providers across the state. In my 15 years with Centers for Independent Living, I’ve never seen anything quite like this. I urge everyone to advocate. Make your voice heard. These cuts could affect us all and we need to stand united and not back down.