State of Nevada Medicaid Homecare Policy Proposal

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Homecare Policy

Nevada Medicaid is poised to stop all contracting with individuals who provide care for some of our elderly and disabled people.

There is updated information on this issue and other related Nevada Medicaid home care policies.

assistant-and-disabled-younNevada Medicaid administrators, Chuck Duarte and Michael Wilden, are moving to eliminate all contracting with individuals who provide homecare services for some of Nevada's disabled and elderly.  This change to only allow agency provided homecare, will not save the State money.  But, it will streamline the duties of some administrators of the homecare program.

The administrators are taking this action in spite of pleas from disabled people who will be losing this important resource of homecare.  Below, is a letter from one disabled person who will be effected.  He is responding to the Division’s staunch rejection of their plea to allow these individuals to continue supplying at-home-care.

Although the Division has made its current position quite clear, one pivotal question still remains... “Is this Department willing to follow through with this policy change, even if it will likely result in the harm of some disabled people?”

Dear Mr. Wilden,
I was honestly appalled by your response letter (authored by Mr. Duarte).  It was a cold rejection of our plea to retain and bolster the Independent Caregiver option. The content was specious.  Hopefully the Governor's Office will not be convinced by such glamorization of a policy change that may well harm many Nevadans who are elderly or disabled.

Are you overlooking the fact that a severe caregiver shortage is developing?  When there are not enough caregivers to provide the personal assistance that people need, folks are forced into institutional settings.  How is eliminating a homecare resource addressing this problem? Obviously, curtailing any viable homecare resource can only worsen the problem. 

When that happens, the actions you are now taking, to streamline your administrative duties (and to please First Health Corporation), will be proven a gross neglect of Nevada's disabled and elderly people.  I recognize it's more work for the Division.  But at the same time, isn't helping people the heart of your mission and aren't these people worth more than the preferences of First Health Corp.?

It seems, your department is once again choosing administrative ease over compassionate leadership.  I pray that you will prove me wrong.  Doesn't a proper decision come down to how you answer the following question...  Is this Department willing to follow through with this policy change, even if it likely will hurt some people?

Your plan to eliminate the Independent Caregivers may eventually harm very many people. Implementing your plan will immediately cause harm to some disabled folks... For a few of us, the factors listed below will equate to the loss of some existing home caregivers, or forfeiture of self-directed care, or the increased possibility of institutionalization.

  • Lowering the wage offered to caregivers by $3-$4 per hour. (This caregiver wage reduction money goes into the pockets of healthcare agencies, not the State or the participant.)
  • Forcing existing caregivers to accept employment through a third-party agency will jeopardize their continued service.
  • Practical difficulties of the new self-directed care models will make it tough or impossible for some participants to access them... especially the employership model.

By answering the following questions, you should be able to surmise when and how people will be adversely effected.

  • Will participants using the ISO agency, find it easier to recruit caregivers by offering lower wages?
  • Can we expect that all transitioning caregivers will follow their clients into the new system?
  • Will all participants, who would choose the employership model, be able to handle the responsibilities of formal employership?

Can you see how that if the Independent Caregiver is not properly established as an accessible and workable alternative, some people will be harmed?

  • Some disabled people will suffer loss of their existing home caregivers.
  • Some will not be able to access the self-directed employership model.
  • With significantly lowered caregiver wages, all participants will find it harder to hire self-directed homecare. Whenever adequate homecare staff cannot be hired, some of us this will face the depravity of institutionalization.

Mr. Wilden, we are asking that you would enhance the Independent Caregiver option, not destroy it.  You can make our homecare workable, cost-efficient and independence granting.  Please encourage the use of individuals as caregivers, especially in those circumstances where it will prevent the situations I have described above. 

Sincerely, Rick Cline

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