South Bend Tribune
7:47 PM EDT, August 23, 2012
SOUTH BEND -- About 6,100 senior and disabled Hoosiers are on a waiting list for services -- known as the CHOICE program -- that would keep them at home rather than having to go to a nursing home, which is vastly more expensive.
Three senior advocates from Indianapolis say the list could be pared down greatly if the state hadn't taken $18.1 million from CHOICE to use as the match for federal Medicaid dollars.
Why not, John Cardwell asked, tap into the Indiana's $2.2 billion surplus instead?
Cardwell helped to draft the state statute in 1987 that provided for CHOICE and now serves as chairman of the Indiana Home Care Task Force. On Thursday, he came with two other senior advocates from Indianapolis to the nonprofit REAL Services to push that question.
But that match was set in a budget that was passed two years ago -- at a time when the big surplus wasn't there, said Susan Waschevski, deputy director for home and community based services in the state's Division of Aging.
Every dollar that the state offers for a match yields $2 in federal Medicaid money, she said.
Since CHOICE is a state program, it doesn't trigger the match. The Medicaid waiver program, which is similar but for low-income people with greater needs for daily help, does leverage the federal dollars. So, that's where the state put the $18.1 million -- to serve the "neediest of the needy," Waschevski said.
About 2,800 Hoosiers are on the wait list for the Medicaid waiver, a number that Cardwell also argued needs to come down.
But Waschevski said it's down from about 4,200 in April and 6,000 a couple of years ago. The goal is to lower it to zero by the end of the year, she said.
There often are the same people on both that list and the CHOICE list, as well as the 96 people now on the state's Medicaid-funded traumatic brain injury waiver, she said. Each of them provides at-home care.
The 6,100 on the CHOICE waiting list is down just a bit from about 6,400 in June 2011, she said.
Without home-based care, clients get sicker and family members have to quit work, said June Holt, assistant director of The Generations Project.
Holt said she dropped out of work for a few years, too, after her son's brain tumor ruptured at age 25.
"I was lucky I had a job to come back to," said Holt, whose son, now 33, lives in his own apartment thanks to services provided through the Medicaid waiver.
"Hoosiers want to do things for themselves," she said. "They can't do that in a nursing home."
The state estimates that CHOICE costs an average of $7,500 per year, though advocates put it at $4,000 per year.
By contrast, the state estimates a year in a nursing home costs about $45,000, though advocates say it's nearly $58,000 per year.
Cardwell said the federal administration, from President George W. Bush to President Barack Obama, has encouraged states to use home-based care in their Medicaid programs to save money.
"This is just good common sense," Cardwell said.
The state General Assembly has given CHOICE lots of support over the years, but since 2005, he said, the governor's administration has restricted the funding.
If it gets full funding, he said, it will go a long way to reduce the 29,000 people now in nursing homes on Medicaid funding.
Staff writer Joseph Dits:
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