Texas moves towards home- and community-based services for disabled people, via Community First Choice | Arkansas Blog

Tuesday, December 1, 2015

Texas moves towards home- and community-based services for disabled people, via Community First Choice

Posted By on Tue, Dec 1, 2015 at 2:18 PM

TEXAS MEDICAID: Creepy logo, right idea on long-term care.
  • TEXAS MEDICAID: Creepy logo, right idea on long-term care.

The Dallas Morning News reports
on Texas' implementation of a Medicaid reform initiative that's been the subject of an ongoing, low-level battle in Arkansas: the Community First Choice Option, a program that would allow people in need of long-term care to get services at home or in their communities, rather than being institutionalized. 

CFC will allow thousands of Texans with developmental disabilities to access services they've previously been denied. (Texas has dropped the word "option" from the name, so in this post I'll refer to both the Texas program and the hypothetical Arkansas program with the "CFC" abbreviation.) Although CFC is part of the Affordable Care Act, conservative legislators in Texas have apparently embraced the program because of promised cost savings. In Arkansas, as we reported in 2014, the association with Obamacare helped to sink CFC among state legislators. Pressure from the nursing home lobby likely didn't help, either.

In the past, both Texas Medicaid and Arkansas Medicaid generally have steered people with disabilities into institutions, even if it's cheaper to care for them in a less-restrictive setting, such as a group home. And it almost always is cheaper, as the Dallas Morning News reports:

Texas ... operates more institutions for people with disabilities than any other state: 13 centers for 3,362 people.

In 2012, Texas spent $166,643 per person to keep them in a state institution, compared with $39,947 per person it pays for people with disabilities to live in a community. The funding for community-based programs went down 5.8 percent in two years, according to the Texas Council for Developmental Disabilities.

This is why Texas has consistently ranked almost last in the U.S. in providing services for people with disabilities, said Kyle Piccola, government affairs director for the disability rights group ARC of Texas. He and other groups say the root cause is legislators’ general aversion to funding social programs like Medicaid.

Medicaid is supposed to provide adults with services to live in their own homes or apartments, but the waiting lists for it are so backlogged that tens of thousands are left waiting a long time.

We've got the same problem here in Arkansas. There are about 3,000 developmentally disabled Arkansans on a waiting list to receive "waiver services," meaning Medicaid dollars normally used to pay for the exorbitant cost of institutionalization would instead be used to pay for at-home care or a group home or some other "community-based" option. But there's a cap on how many people can receive waivers, and many of the families on have been on a waiting list for seven or eight years, during which time they're simply foregoing many Medicaid services altogether. 

Texas' waiting list problem is even worse than Arkansas's on a per-capita basis: There are an incredible 102,000 people on the waiting list there. (Texas' population is nine times as large as ours, but its waiting list is 34 times as large.)

However, Texas is now addressing the problem. CFC will help it move people off its swollen waiting list, with some $116 million in additional funding approved for the next two fiscal years alone. That's made possible in large part by extra federal money provided to states that agree to implement CFC (the money comes in the form of an enhanced match rate, which is explained here).

This all has relevance for Arkansas because a big overhaul of the state's Medicaid system is in the works. As David Ramsey reported last week, the discussion in the legislature has shifted from empty threats of dismantling the private option — the Medicaid expansion for low-income, non-disabled adults implemented in 2013 — to talk of cost-savings in other Medicaid programs, including developmental disabilities. One big piece of that picture is the fact that institutional care simply costs much more than community-based services. In fact, even without CFC and its extra federal dollars, Arkansas could cut costs dramatically by a shift away from institutionalization.

That's been among the most significant conclusions of the Stephen Group, the consultant hired by the legislature to investigate options for Medicaid reform. CFC or no CFC, said the consultants, the state needs to shift towards home- and community-based care.

This would help save money. More importantly, it would help thousands of disabled people and their families live better, more independent lives. However, there are big hurdles ahead — namely that providers such as nursing homes want to preserve the old model of institutionalization-as-the-norm. And while shifting towards home- and community-based services is in itself a good idea, the debate may get tangled in larger, thornier questions about "managed care" in the Medicaid program writ large.

It's very good news that Texas is finally trying to correct its deficiencies in the way it treats its disabled residents. Of course, let's not get carried away — there are still around 750,000 low-income citizens in Texas without insurance simply because the state wants to thumb its nose at the Obama administration by refusing the ACA's expansion of Medicaid for the poor. Arkansas had the good sense to accept that money — but then that was in a different political universe, in 2013.

Tags: , , , , , , , , , , , , ,

From the ArkTimes store

Favorite

Comments (4)

Showing 1-4 of 4

Add a comment

 
Subscribe to this thread:
Showing 1-4 of 4

Add a comment

More by Benjamin Hardy

  • Senate bill imperils rural health care, hospital leaders warn

    In the four years since Arkansas chose to expand Medicaid under the Affordable Care Act, Harris Medical Center in Newport has seen its “bad debt” — bills left unpaid by patients — cut in half. Eight percent of the 133-bed hospital’s patients fell into the bad debt category in 2013, the year before Arkansas created the hybrid Medicaid expansion program known as the private option (later rebranded by Governor Hutchinson as “Arkansas Works”). Today, that figure is 4 percent, according to Harris Medical Center CEO Darrin Caldwell.
    • Jul 13, 2017
  • Beyond repeal of Obamacare

    The proposed Medicaid cuts in the new U.S. Senate bill could impact coverage for 400,000 Arkansas children.
    • Jun 29, 2017
  • Study: Arkansas tops nation for percentage of rural children on Medicaid

    Almost two-thirds of children in Arkansas’s small towns and rural areas receive health care coverage through Medicaid, according to a report released Wednesday by researchers at Georgetown University and the University of North Carolina — the highest percentage of any state in the nation.
    • Jun 7, 2017
  • More »

Readers also liked…

  • Super Bowl line

    Over to you.
    • Feb 7, 2016
  • Judge Griffen: Why black lives matter

    Another few words from Judge Wendell Griffen growing from the controversy over the sale of Black Lives Matter T-shirts at the state black history museum — removed by the administration and restored after protests from Griffen and others stirred by a story in the Arkansas Times:
    • Mar 13, 2016
  • Kenneth Starr: A comment from Betsey Wright

    Betsey Wright, former President Bill Clinton's chief of staff when he was Arkansas governor, responds bitterly to a New York Times article today quoting Whitewater Prosecutor Kenneth Starr's warm words about Clinton. She can't forget the lives Starr ruined in Arkansas.
    • May 24, 2016

Most Shared

  • So much for a school settlement in Pulaski County

    The Arkansas Democrat-Gazette's Cynthia Howell got the scoop on what appears to be coming upheaval in the Pulaski County School District along with the likely end of any chance of a speedy resolution of school desegregation issues in Pulaski County.
  • Riverfest calls it quits

    The board of directors of Riverfest, Arkansas's largest and longest running music festival, announced today that the festival will no longer be held. Riverfest celebrated its 40th anniversary in June. A press release blamed competition from other festivals and the rising cost of performers fees for the decision.
  • Football for UA Little Rock

    Andrew Rogerson, the new chancellor at UA Little Rock, has decided to study the cost of starting a major college football team on campus (plus a marching band). Technically, it would be a revival of football, dropped more than 60 years ago when the school was a junior college.
  • Turn to baseball

    When the world threatens to get you down, there is always baseball — an absorbing refuge, an alternate reality entirely unto itself.

Most Viewed

Most Recent Comments

Blogroll

 

© 2017 Arkansas Times | 201 East Markham, Suite 200, Little Rock, AR 72201
Powered by Foundation