Cuts to hospice care announced by state officials last week are deeper than originally portrayed, eliminating hospice treatment for all Medicaid recipients starting in February, the Louisiana Department of Health and Hospitals said Wednesday. In announcing the reductions to hospice care, which aims to make dying people more comfortable in the last six months of their lives, Jindal administration officials said the cutbacks would force people on Medicaid to seek the service in a nursing home. But the change actually means the state is eliminating all hospice care ? both at home and in nursing facilities -- to people covered by Medicaid.
Jamey Boudreaux, executive director of the Louisiana-Mississippi Hospice and Palliative Care Organization, said he learned from the health department earlier this week that the initial characterization of the cut was a ?misstatement.?
In an email, Kathleen Meyers, a spokeswoman for the state health agency, confirmed that the hospice cuts are a ?service elimination.?
?Effective Feb. 1, 2013, Medicaid will no longer reimburse for hospice services,? Meyers wrote. People currently in hospice will keep those services through the rest of their lives.
Most people in hospice in Louisiana are elderly and, therefore, have their end-of-life care covered by Medicare, Boudreaux said. But more than 5,800 Medicaid patients received hospice benefits this year, according to state figures.
This care is usually provided in patients? homes, where they are most comfortable, Boudreaux said. Hospice workers include not only doctors and nurses, but social workers and a chaplain, who meet to reassess the treatment plan for terminally ill patients every 15 days, he said.
While cutting hospice care is slated to trim the state portion of the Medicaid budget by $1.1 million, Boudreaux predicted it wouldn?t actually result in savings. This is because many dying people will end up at hospitals, where Medicaid will pay for at least a portion of their care.
?I predict they will spend at least four times that amount in emergency room visits and hospitalization of those type of folks,? Boudreaux said.
In the email, Meyers wrote that dying people will still be able to access pain medication through the Medicaid pharmacy program, while home health services will also be available. The ?emotional support? services offered by hospice teams will be eliminated, but Meyers emphasized that the state will connect nonprofit and faith-based groups with dying Medicaid recipients in need of help.
Legislators at a Friday hearing to discuss the $165.5 million in reductions and other budget fixes were especially alarmed by the hospice cuts. The cuts are needed because a revenue shortfall has thrown the the state?s budget out of whack. The budget must be balanced by the time the fiscal year ends on June 30.
Bruce Greenstein, the state?s health secretary, emphasized on Friday afternoon that the nursing-home-based care would still be available.
"For those in their last years or days and weeks of life, nursing homes do a very good job," Greenstein said.
The cuts take aim at a number of health care programs, many financed by the Medicaid insurance program for the poor. One exception is the ending of a small program that largely uses federal welfare dollars to provide unique mental health treatment to very young children.
Dr. Mary Margaret Gleason, co-clinical director of the Early Childhood Supports and Services program, said the children treated in her program come from low-income families, many helmed by parents with their own mental health problems. Many of the children have experienced some kind of violence or otherwise are at risk for developing mental health problems, she said.
Eliminating the 10-year-old program will save $134,561 in state funds, which is used to get a match of $2.7 million from the federal welfare program. There currently are 540 children aged 6 or younger enrolled in the program statewide.
Gleason said her program includes both case managers and clinicians who work with children with mood disorders, depression and other serious problems that result in them acting out in daycare, school or at home.
Staffers not only work with the children themselves, but also parents, trying to make sure parents know how to deal with their kids, she said.
Desiree Waguespack, whose son was treated in the St. Tammany part of the program for about two years, said it was transformative. Before the program, she received calls from daycare or pre-school an average of three times a week. ?To the point where the phone rang and I would cringe,? she said.
But as she and her son worked with the Early Childhood case manager, things changed. Waugespack said she learned how to respond to her son?s outbursts and aggression. He is now a happy child and good student.
?He?s a kid who I no longer fear for his future,? she said. ?It is huge.?
The state health department emphasized Friday that children can get mental health treatment from the state Behavioral Health Partnership, which is run by the private company Magellan of Louisiana.
Gleason was skeptical, saying that while she thinks the state?s idea of providing coordinated mental health treatment through the partnership is a good idea, many of the existing services outside her program don?t have staffers trained to either assess or work with young children with serious problems.
In an email, Meyers wrote that all the children in the early childhood program are ?being reviewed to determine his or her ongoing needs and identify resources for ongoing support.? Children will be referred to providers who specialize in treating children, she wrote.
Source: http://www.nola.com/health/index.ssf/2012/12/state_medicaid_hospice_cuts_de.html
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