Proposed cuts to California MSSP programs for vulnerable frail seniors could result in increased nursing home placements

The following is the prepared testimony of Sandy Atkins, COO of Partners in Care, who appeared before the California Senate Budget Subcommittee #3, April 10, 2008, Sacramento. The actual testimony was abridged due to time allowed.

My name is Sandy Atkins. I am the chief operating officer of Partners in Care Foundation, which runs two MSSP sites, an Adult Day Health Center, an Alzheimer’s Day Care Resource Center, and also works to create positive change in health and health care through collaborative research, dissemination, and education.

The MSSP program is a proven, cost-effective service that keeps people out of nursing homes. I was project director at USC for California Long Term Care Integration Center and helped analyze combined Medi-Cal, IHSS, and MSSP claims data for 19 counties. The annual difference in total Medi-Cal expenditures between a nursing-home eligible person in the MSSP program and a person permanently staying in a nursing home amounts to a $16,000 savings per year per MSSP client. Calculations by the US Centers for Medicare and Medicaid Services (CMS) support these numbers.

Our society has strongly expressed – both legally and in the consensus of the people – that becoming institutionalized should not be the necessary end for the aged and disabled. The state is required by the Olmstead decision to provide meaningful alternatives to institutional care for disabled individuals, yet cutting this program will decrease the state’s compliance with this important Supreme Court ruling.

There is no “fat” in an MSSP budget. Twenty years with only one budget increase have assured that. Partners in Care’s two MSSP sites will be forced to curtail the number of frail elders we serve, and, by extension, their families. We will have to serve 50 fewer people in our South Central LA program and 21 fewer people in northwest LA County, including the Antelope Valley. These are areas where the need is especially huge because of the concentration of low-income people.

We estimate 20% of the approximately 92 people whom we will be unable to serve will be forced to go to a nursing home – possibly more because we have been seeing increasingly vulnerable people among our applicants over the past year . The state would “save” about $322,000 (minus the federal match), but in exchange would incur over $640,000 in new nursing home costs in one year, even considering a 10% decrease in SNF reimbursement. And the costs will last as long as these people live.

But when you toss this stone into the pond, the waves move swiftly to cause even more damage. Some caregivers of our clients would need to give up work – more loss of income tax revenue and very likely a conversion from private health insurance to Medi-Cal. Plus these same people would stop saving for their own retirement, perpetuating the need for publicly funded services in the next few decades. These caregivers would themselves be more prone to stress, health problems such as high blood pressure and depression, and, yes, even premature death.

The questions I would pose to you are these: How do we comply with the Olmstead decision? How do we keep frail elders independent and out of costly nursing homes? And how can we prevent caregiver burnout if the state continues chip away at a program that successfully addresses all of these challenges?

Now, I don’t want to come to you only with problems – there are solutions beyond cutting essential programs. I am a taxpayer and would gladly pay more to support frail elders and other vulnerable members of our community. I suggest that you also look at ways to increase revenue by increasing user taxes on things that decrease health in the community such as cigarettes and junk food.

Finally, I urge you to do the hard work of targeting cuts to budget areas that do not result in increased victimization of the more unfortunate people in our community. Cut programs where tightening the belt will increase efficiency, not destroy lives. Make cuts where they will have a positive fiscal effect, not one that increases both costs and suffering.

A 10% across-the-board cut is not “sharing the pain” – it amounts to targeting the pain directly at low-income and medically needy members of our community. We can and must do better than that.


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