Medicaid benefits that pay for people with disabilities to go on community outings and cover household cleaning, cooking and laundry are the latest services facing cuts as Colorado deals with a major budget shortage.
A governor-appointed board that sets rules for the state Medicaid program voted 6-1 Friday to preliminarily approve the cuts, despite rejecting other cuts requested by Medicaid officials this year.
The federal-state health insurance program will save $1.2 million in state money this year and $10 million next year by placing stricter caps on the number of hours that caregivers are paid to take people on outings through a benefit called “community connector.” Capping the hours allowed for “homemaker” services, which include cooking and cleaning, will save Medicaid $2.6 million state funds.
The community connector program in particular has ballooned — the cost of the program jumped by 1,178% since 2018, to about $67 million per year from about $5 million per year.
Part of the growth is because people are using it incorrectly, Medicaid officials said.
The benefit is intended to take people with disabilities on outings to learn to ride public transportation, grocery shop or volunteer at a library. Yet requests have included a 3-year-old needing 20 hours per week to improve social skills and a 16-year-old asking for 20 hours per week to deal with a screen addiction, said Bonnie Silva, director of the state health care department’s Office of Community Living.
In some cases, people are using the benefit to go to restaurants or the movies, which are not outings to “engage in their community” as the program is meant to do, Silva said. The program is not intended to pay for duties that are “typical parental responsibility,” she said.
Board members who supported the department’s emergency rule change said they wanted to keep the benefits afloat for the long term, which would require reining in the spending. Laura Carroll, the head of the volunteer Medical Services Board, was the only no vote.
The vote Friday came at the end of a nearly five-hour meeting, which included emotional testimony from numerous parents who gave up working outside the home when they had children with severe disabilities.
Briana Hayes, the mother of a 4-year-old girl with a genetic disorder and multiple health issues, did her own math and determined the state would not save money, at least in her daughter’s case.
Hayes’ daughter receives $8,000 in services per month so that she can live at home, including 10 hours to go on community outings, 31 hours for nursing care and a few hours of homemaker services, which are for cleaning, laundry and meal preparation.
Cuts to those benefits will mean that Hayes “would have to get a job outside the home” and would place her daughter in daytime care, which costs $57 per hour, she said. The monthly cost for Medicaid would jump to $11,500 from the current $8,000, Hayes said.
“I urge you to object to this rule in favor of young kids with disabilities,” Hayes told the board.
Others said the cuts were unfair in particular to single parents and argued that it’s not cost-effective to cut services that help people live at home instead of in institutions.
The vote was the most recent in several medical board, legislative and Colorado Department of Health Care Policy and Financing meetings to attempt to trim Medicaid costs, which now make up one-third of the state budget.
In January, the medical board refused to even make a motion to approve a previous department request for cuts, another emergency rule change that would have meant a 10% rate cut for parents who are providing round-the-clock care to adult children with disabilities.
Then, after hours of tearful testimony, the legislature’s Joint Budget Committee refused to cap the number of hours family caregivers could bill for care or reduce their hourly benefit rate to match what is allowed for group homes.
Medicaid officials say current spending is not sustainable. Previous policy decisions to expand coverage, boosted by COVID-era spending, are now breaking the budget. Medicaid spending has grown about 9% during the past decade, and the long-term care portion of Medicaid jumped to $4.1 billion from $2.9 billion in just three years.
The health care department’s “goal is to take a holistic and forward-sighted approach to a balanced budget and program sustainability,” state officials wrote in their pitch for the latest emergency rule change. “It is imperative that changes are also made that focus on trend drivers and the maximization of federal funds to avoid larger draconian cuts.”
The board’s vote on the community connector and homemaker programs was preliminary, with a final vote in 120 days.