Currently in Congress, the focus on health care policy will likely continue to be Social Security followed by Medicaid and Medicare, in that order. The House Ways and Means Committee Chairman Bill Thomas has mentioned rethinking all of these important government programs and the way in which they are funded by American taxpayers. But there has been a storm of concern not only among the public but members of Congress about possible changes to these programs.
President Bush accelerated his efforts to sell the need for Social Security reform throughout the month of March by reaching seniors and near-retirees during several personal appearances to capture their support for change. Most members of Congress would like to see this year utilized as a plan to examine the crisis in Social Security and to educate their constituents, coming back to Social Security reform in the next congressional session. It's essential that our home care community follow this issue, because Congress may look to adding long-term care (including home care) as a factor in the financing of this program.
During the National Governors Association's winter meeting in Washington, the debate continued over the federal and state burden-sharing of Medicaid. President Bush and the governors worked hard to find common ground, focusing on cost-effectiveness, increased patient access, improved outcomes for beneficiaries and advances in health care technology.
One great point that all parties seem to agree on is a recognition that home care and community-based care are a preferred alternative to nursing homes. It's obvious to us that home care is patient-preferred and cost-effective. There was no disagreement among the governors and Secretary of Health and Human Services Michael Leavitt, a former governor of Utah, that change must take place in the current role for Medicaid in order to provide care for the more than 50 million beneficiaries in the United States.
Home care providers across the nation are already facing serious cuts in Medicaid payments. State home care associations, which champion home care before their state legislatures, governors and Medicaid agencies, report a broad array of challenges. While some states report favorable Medicaid policies, others report that severe cuts are possible.
There are as many different Medicaid challenges in home care as there are states with tight budgets. Michigan has faced a nearly 50 percent cut in oxygen concentrator reimbursement. Steve Slater, general manager of Airway Oxygen and president of the Michigan Home Health Association, and Harvey Zuckerberg, executive director of the Michigan association, have worked with the Medicaid task force of the association for several months to avert this cut, which would drastically reduce patient access to home oxygen therapy as well as the viability of providing oxygen.
In Pennsylvania, there is a proposed $5,000 per year cap on DME for adult patients under the state's Medicaid program in the 2005-2006 budget. In a letter to the state Medicaid budget contractor, Dave Fiorini, executive director of the Pennsylvania Association of Medical Suppliers (PAMS), said, “We believe the cap on DME will have an adverse effect on the disabled and financially distressed patients we care for in the home. This plan is in direct contradiction to President George Bush's and Governor Ed Rendell's initiatives to focus on community- and home-based care.” PAMS is discussing the proposal with Pennsylvania legislators.
AAHomecare will continue the battle to protect home care benefits in Medicaid and Medicare as one of its top priorities this year. The entire home care community at the state level and in Washington will need to continue to work together to strengthen and preserve home care access and benefits for the millions of Americans who need them.
As we take the necessary steps to protect any home care benefit — whether it be in a Social Security, Medicaid or Medicare segment — the mission is the same: We put patients first, with policy to make the mission possible.
Kay Cox is president and CEO of the American Association for Homecare, Alexandria, Va. For more information about AAHomecare, visit www.aahomecare.org, or call 703/836-6263.
