| Dr. Gema Hernandez asks an
important question: Will Florida agencies on aging survive the Jeb Bush
Administration, and what is the implication for them under another
George W. Bush administration?
Some of us are thinking that with
God’s help and
our pro active behavior we will never need the Medicaid waiver
program.
But while we plan and try to
anticipate all the options historical data is not in our side.
Some of us, whether we like it or not
may need the Medicaid waiver program to help keep us at home. Will the
program be there for us when we need it?
If you want to see the future
look at what is happening in Florida today.
This legislative session bills have
been introduced that will move the entire Medicaid waiver programs from
the Department of Elder Affairs to the Agency for Health Care
Administration.
The move will end the leadership
position the Department of Elder Affairs has had since its inception in
1992 as the lead department on policy issues of Long Term Care.
It will also terminate the role
the Area Agencies on Aging have over the allocation of Medicaid waiver
dollars in their respective service areas.
For some the removal of the Department of Elder Affairs and of the
Area Agencies on Aging from the distribution of the Medicaid waiver
dollars is a good thing because it eliminates two administrative layers,
each layer keeping a percentage of dollars to administer the Medicaid
waiver program.
Less layers means more money going
directly to service for the elders. However, I happen to disagree with
the change.
The idea of such a plan is not new, it was first introduced in 2001
during the Nursing Home hearings, but it was stopped from further
implementation because at that point the commission, a commission of
which I was a member, presented objections to the “integration plan”
and the move of all Medicaid waiver services to another department.
My disagreement with the plan is based
on the fact that unless the Department of Elder Affairs or the State
Unit on Aging keeps control of the Medicaid waiver program for elders,
fewer elders will be able to receive the benefit of the program. Once
the Medicaid waiver program moves over to the Agency of Health Care
Administration, elders would have to compete with children and disabled
adults to access those dollars.
My disagreement with the plan also
goes back to the purpose for which the Department of Elder Affairs was
created back in 1992 by the Florida voters. It also goes back to the
Older Americans Act and the position the State Units on Aging.
The people of Florida voted to create
a Department so all the issues that impacted elders will not be
fragmented, but will be in one place. Medicaid waivers are an important
piece of that financial puzzle.
Consider the following data: The
funding to support both the existence of the State Units on Aging and
the Area Agency on Aging comes from several sources, but if the Medicaid
waiver piece is removed from both it can be said that 65% of the funding
will disappear, leaving maybe 80 million dollars to support all
operations and programs.
Can the Department and the Area
Agencies survive with 35% of its present budget? I don’t think they
can.
Some people would argue that the
Agency for Health Care Administration will contract with the Area
Agencies on Aging, this way the status quo will be maintained and the
Area Agencies will be preserved.
While maybe this year because it is an
election year the contract will continue, if the Agency for Health Care
Administration is trying to save money it does not make sense to keep
the middle agency in place.
Add to this the fact that by 2006, the
administration needs to move 35% of the Medicare recipients to a Managed
Care Organization. If 35% of the Medicare recipients are not enrolled in
an HMO the Modernization of the Medicare program will be a total fiasco,
more than it is at this point.
HMO will try to keep a higher
percentage of the government payment, and to do that they will integrate
the acute and long term care services into one capitated rate leaving
out again the middle agency.
If the above information is still not
enough to convince you that we have enter a new era in the delivery of
services to elders consider the final facts Governor Jeb Bush, the
brother of the president, wants to Modernize Medicaid and he wants to do
it now.
The fine print of the proposal reads
like the same integrated managed long term care system proposed in 2001.
This is a system that have no use for the Area Agencies on Aging unless
they case managed cases and even case managing cases is problematic for
HMO who are going to be in the driver seat. The change is like a domino
effect. If States Units on Aging are no longer the leader in long
term care, what role will it play in the Consumer Directed Care
Initiative?
Shall the Agency for Health Care
Administration become also the lead agency in the Consumer Directed Care
project? This change comes at a time when no funding has been
obtained to provide services to extremely frail elders.
What will happen to all those
elders with a frailty level similar to the Nursing Home residents? Do
they have another year to spare and to wait until help comes their way?
In life there is the best of times and
the worst of times for our elders, and their caregivers in need of
community based services, these are the worst of times. |