Tuesday, May 21, 2013
WINTHROP — In an old farmhouse on a rural road, 24 elderly Mainers live in a residential care facility that would run out of money July 1 under a proposal by Gov. Paul LePage.
WHAT ARE PRIVATE NON-MEDICAL INSTITUTIONS?
• Residential treatment services funded by MaineCare.
• Operated by agencies or facilities.
• Licensed by the Maine DHHS.
• Provide rehabilitative treatment to four or more residents.
• Provide food, shelter and personal care.
• Give treatment that is medically necessary.
The Heritage Rehabilitation and Living Center is one of about 470 private non-medical institutions scattered around the state that are supported mostly by state and federal Medicaid dollars. They are home to people like Errie Hasty, 89, who moved in almost five years ago when she could no longer manage her medications by herself.
"I wasn't giving myself the right stuff," she said as she stood in the dining hall, using a walker to steady herself.
Hasty is one of the 4,291 elderly people in the state who would need to find somewhere else to live if the facilities close. Many of them would be eligible to live in nursing homes, but there are only about 400 available beds statewide, advocates for the elderly say. The facilities also provide residential care to those with mental illness or substance abuse problems, so the total number of people affected by the loss of funding is about 6,000.
Closing the facilities would save the state $60 million and reduce federal matching funds that the state receives by more than $100 million.
When it comes to controversial parts of LePage's proposal to close a $221 million budget shortfall at the state Department of Health and Human Services, this is at the top of many lawmakers' lists.
"Assuming 10 is most important, I would put it at 10," said Rep. Meredith Strang Burgess, R-Cumberland, House chairwoman of the Legislature's Health and Human Services Committee.
That committee and members of the Appropriations Committee will meet today to continue deliberations on the budget, which proposes to end Medicaid coverage for 65,000 Mainers.
The LePage administration says the residential care program is no longer sustainable as currently structured because the federal government is raising questions about the way Maine has billed for services. LePage spokeswoman Adrienne Bennett says there is money in the budget to help transition away from the system, but the budget does not spell out an alternative.
That's up to lawmakers.
Sen. Roger Katz, R-Augusta, a member of the Appropriations Committee, said he's confident lawmakers will find a way to answer the federal government's questions and maintain the state's eligibility for reimbursement for the residential care services. But they will then have to find other ways to save the $60 million. Overall, the state does need to reduce the number of people enrolled in MaineCare, the state's Medicaid program, Katz said.
"We've got to come back to fiscal sanity and still protect the most vulnerable," he said.
Rep. John Martin, D-Eagle Lake, also a member of the Appropriations Committee, said there's little chance the proposal to close the facilities will have any traction at the State House.
"I don't know of any legislator that would ever vote for that," he said, noting that it's the part of the budget that has the most immediate impact on people.
These types of assisted-living facilities began to open in the mid-to-late 1990s, when the state decided it wanted to reduce the number of people living in nursing homes to cut costs, said Rick Erb, president of the Maine Health Care Association. Nursing homes are a more expensive way to provide care, and in today's dollars, cost Medicaid about $178 per day. Assisted-living facilities cost about $98.
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