Kristi Allen photo
Home care providers decry Medicaid cuts (Kristi Allen photo)

Members of the Connecticut Association of Healthcare at Home told state officials Thursday that they’re concerned what will happen if their Medicaid reimbursements are cut 15 percent.

Agencies who provide the behavioral health services to patients in their home are concerned the scheduled July 1 cuts will mean they will have to layoff employees and patients won’t get the medication and care they need.

“Access to mental health care will become a critical issue facing this segment of the population, which has a very real likelihood of increasing hospital visits and increasing the crime rate and homelessness,”  Indy Edwards, vice president of operations at Kindred at Home, said.”Many communities in Connecticut will not be served and employees will lose their jobs…It’s simply the wrong thing to do.”

Medication administration, the area of mental health services taking the cut, involves nurses making home visits to patients to make sure that their medications are delivered correctly and safely. It’s become a large part of mental health treatment during the past two decades as the industry has moved away from institutionalization towards home-based care and treatment.

Connecticut spends $115 million a year to deliver medication to its 6,700 patients (not including the cost of the meds themselves), a figure the state has been trying to reduce for years.

State officials said that these services have been over budget for years and they can’t afford to ignore it in Connecticut’s new economic reality.

“The amount spent solely on administering the medications represents almost half of what Medicaid spends on all home health care,” said Department of Social Services Communications Director David Dearborn. “We are in a serious budgetary situation, and we have been trying to achieve budget savings enacted by the legislature

In 2013, the state implemented a budget that assumed medication administration costs could be cut by $20 million annually. The agencies were told to save money by replacing nurse visits with ‘med boxes’ that dispense single doses of medication and employ cheaper home health aides.

The agencies have not been able to find the $20 million in savings with these strategies, so the Office of Policy and Management and DSS officials say a rate cut is the only option they have left to bring medication administration spending under budget.

“We’re a break-even operation and this is all we do,” Continuum Home Health CFO Martin Morrissey said. “The cost to deliver a visit is $60. We’re gonna get paid about $50 now. We can’t make it up on volume and we’re losing with every visit.

Home care providers say that they’ve tried to work with DSS on cost savings, but in most cases, there’s simply no cheaper alternative for the care they’re providing.

“The RNs really struggled with being able to find patients that they felt were chronic and stable enough” to receive medication from a less experienced home health aide or a med box,” Tracy Wodatch, vice president for Clinical and Regulatory Services at the CT Association for Home Health Care, said.

Many of the providers said they also had trouble finding people to hire as home health aides. 

“There does not seem to be enough volume of people in the market in Connecticut,” said Patty Walker of Continuum Health Services, a sentiment many of the other providers echoed. Of the 16 home health aides that Bree Sanca of Salute Home Care had hired, only two were willing to work with mental health patients. When they could be hired, aides had to complete about 30 hours of training, pass a written test, and be approved by the nurse after observation in the field.

Providers also stressed that while the state was focused on medication delivery cost savings, the work they do far exceeds simply handing out meds.

“Medication administration is a billing code,” said New England Home Care President Kim Nystrom. “These home care services are not defined by that.”

“When our nurses go in to do medication administration, they open the refrigerator to make sure there’s food. They make sure that the environment is safe, that there’s not hoarding activity going on. We are the safety net for these individuals. Most of these folks do not have family support systems, certainly not sufficient enough to provide them the kind of support they need,” Walker said. 

Moving patients to greater levels of independence and reducing the frequency of the visits they need is the best way to save money, the providers agreed, but it takes time and happens on an individual basis. However, providers said they are now working with physicians and nurses to reduce visits wherever possible to make ends meet.

“I have a list of patients that, financially for us, are very expensive and we’re not going to be able to support them. It’s not a decision we want to make, but we will have to discharge them…There is a reality to what we’ll have to do at that July 1 date,” VNA Healthcare CEO Janine Fay said.

State legislators and officials agreed that the cuts could lead to more people in the state’s crowded jails, but said their hands were tied because the savings are already in the budget.

“My biggest fear is that people will end up on the street or home with families that can’t support them,” Sen. Marilyn Moore, D-Trumbull, said.

The agencies, most with several hundred patients, are scrambling to adapt to the cuts because they say their patients have nowhere else to go.

“This has come as a surprise to us. We received the state plan amendment on May 31st. It anticipated an effective date of July 1. Thirty days is not ample time for our industry to be able to pivot,” CT Association of Healthcare at Home President Deborah Hoyt said. All other providers agreed there’s simply not enough time to adjust both their patients and staff to new regimes.

“A more graduated approach to this would be more cost effective in the long run,” said Edwards.

Asked about the July 1 implementation, DSS spokesman David Dearborn said providers had been aware of the budget situation for years. DSS sent out memos and convened a meeting on the potential rate cuts in February. When asked, he did not say there would be a grace period for providers.

“Legislated budget savings in this area are not being met,” said Dearborn. “We’re continuing to hope that increased use of less costly alternatives will help the service to live within its budget.

But for now, Connecticut’s mental health care providers will have a new set of challenges come July.