Like many of you who have been tracking the budget stories in the media, I flipped the calendar page over to 2010 with a sense of dread. We have known for a long time that this day would be coming—that the state budget would reach this point of structural instability, and that the low hanging fruit we used in the past as budget balancing band aids would all be gone.
Even a few months ago, I didn’t really believe that the BEST case scenario for long-term care providers would be a Medicaid rate freeze. Heading into the 2010 legislative session with a continued budget deficit, with the courts questioning the unallotments from last session, and with a much slower economic recovery than anticipated -- I now believe.
Some, if not all, of our members will be targets for spending reduction proposals. When the budget gap is that large, and the options to fill it are that small, provider rate cuts will be on the table. We can either “wait and take” or we can get all of the tools out of our toolkit. I plan to do the latter. Given the time of year, I thought it would be best if I converted some of these tools into a few of my top resolutions:
I resolve to embroil us in the debate about how and why new revenue (or deficit reduction fees) is needed to minimize the severity of any budget cuts. Go back to the tax levels of pre-1999 and we would see a significant amount of the budget hole filled.
I resolve to speak up about personal responsibility, personal planning and personal contributions toward long-term care expenses whenever the opportunity arises. The word must be spread outside of our long-term care circle that Medicaid is NOT there for everyone’s long-term care needs—the safety net is shrinking.
I resolve to educate, educate, educate and provide members with tools to do the same. Earlier this week we sent you a few copies of brochures that are the starting point for your use in meetings with folks in your community.
I resolve to focus us on where the money is—and that is NOT the state Medicaid program. Extension of federal stimulus funds, third party payments, Medicare, and private dollars . . . that is where the money is.
I resolve to look beyond the current budget deficit to longer term initiatives, particularly in the quality and technology areas.
I resolve to ask the questions that haven’t been publicly asked in the recent past:
Why are health plans (who are receiving state funds) getting increases in their contracts when others are being cut?
Why are the state agencies continuing with “extra” programs and adding staff for new initiatives at a time when there isn’t any money?
Why is there enhanced money being paid for care at the state Veteran’s Homes when those same veterans could be served at a lower cost in their home communities?
Why can’t we align the financing incentives with the policy incentives to serve individuals in their homes as long as possible?
In times of tight budgets, why is the state enforcing policies that limit how many disabled individuals can live in congregate housing settings, knowing that it will cost the state more to serve them in smaller settings?
Why would we maintain a state policy (rate equalization) that prevents privately-paying customers from paying the true cost of their care? The gap between rates and costs today is over $20 per day.
How far should we expect frail elderly to travel to receive the services they need? (Access to “right place/right time” services may soon become an issue.)
Let me know what you think of these “resolutions” and if you’re ready to ask some of these questions, too.
Friday, January 15
New Year's Resolutions from Patti Cullen of Care Providers