Medicaid cuts could be devastating for those who depend on in-home services

July 17--When Rebecca Payne fell and broke her neck, she lost nearly everything.

Her home. Her mobility. The freedom to enjoy her golden years. All gone.

Three years after her fall, and following stays in multiple nursing homes, Medicaid-funded programs allow her to live in her own apartment in Ellettsville, while caregivers take care of her every need 10 hours a day, seven days a week.

Payne, now 63 and a high-functioning quadriplegic with minimal use of her extremities due to an incomplete spinal cord injury, worries constantly about what would happen to her -- and to millions of others with severe disabilities -- if the Republican-majority Congress passes a bill repealing and replacing the Affordable Care Act, severely slashing Medicaid in the process.

Senate Majority Leader Mitch McConnell, R-Ky., on Thursday released yet another discussion draft of the Better Care Reconciliation Act, a bill that would allow minimal health plans as long as insurance providers have at least one ACA-compliant plan, and create larger cash pools to curb the growth of premiums and to combat the opioid epidemic.

But many experts in the field, including the nation's largest physicians group, say the newest draft still falls short on coverage and access, particularly for low-income people on Medicaid -- people like Payne, whose only income is Social Security. The previous draft of the bill would slash Medicaid funding by $772 billion over the next decade. The nonpartisan Congressional Budget Office determined 22 million fewer Americans would have health insurance by 2026 than under the ACA, also known as Obamacare. The CBO is expected to release its report on the latest BCRA draft soon.

"I spend hours every day signing petitions, making phone calls, sending emails to our senators (to tell them) that Trumpcare would be devastating to so many people," Payne said, referring to the BCRA. "Nursing homes would be affected, so people wouldn't be able to (afford) nursing homes. You'd be seeing a lot of elderly and disabled homeless people on the street. I would lose my apartment; I would lose my caregivers.

"I can't imagine how I would make it."

Before moving into her apartment, Payne was shuffled around nursing homes in southern Indiana, rehabbing from her fall at each new place. She hated not having her own space, or control of when she did certain things, such as take a shower or go to bed. She missed the freedom her own home allowed.

"It was horrible. It was a living nightmare," she said.

Jan. 30, 2017 -- the day she moved into her current apartment -- was one of the happiest days of her life. Now, she fears losing it all again.

Payne is not alone.

Kerry Conway, executive director at Area 10 Agency on Aging, said the agency currently serves 601 clients in the area with in-home services. Of those, 334 qualify for some form of long-term care placement and receive services through the Medicaid waiver program. Payne became eligible earlier this year in Indiana's "Money Follows The Person" program, which is designed to get people out of institutions and back into the community and is funded by the federal Centers for Medicare and Medicaid Services.

Getting people back into their own homes is not only the right thing to do, Conway said, but makes the most fiscal sense. On average, the cost for a senior to live in a long-term care facility in the area is $60,000 to $120,000 a year, which Medicare does not cover. But the average cost of in-home services is around $20,000 a year. As many seniors end up having some or all of their fees paid by Medicaid, that is a minimum $40,000 savings per person per year, Conway noted.

"But that is where we, as a state, have been so behind," Conway said.

Indiana ranks overall 51st out of 51 in the nation, Washington, D.C., included, for in-home senior services, according to the AARP's Long-Term Services and Supports Scorecard. If Indiana improved its performance to the average of the top five performing states, $1,122,100,000 more would go to home and community-based services instead of nursing homes.

But without Medicaid, those concerns will be secondary, Conway said.

"If you do not have Medicaid coverage for older adults who need assistance, what's going to happen to them? Will they just go to bed and die?" Conway asked. "How you decide who gets services, who lives and dies, I don't know. But 92-year-olds shouldn't be on waiting lists."

Payne, a former social worker who worked with battered women and children, says there would be no one around to help. She has a daughter who lives in Illinois but has a family of her own to worry about. And although Payne gets along well with her caregivers, no one expects them to work for free.

"I would truly be in dire straits. I think if Trumpcare were to pass, or anything along those lines, people would have to make impossible, impossible decisions," Payne said. "A life can change in a split second, and life as you know it is gone."

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