Advocates say Medicaid waiver could save money and families

Don Colburn/The Oregonian, 8/7/06 (original source )

Advocates say Medicaid waiver could save money and families

Health - Changing the health insurance plan could cut the number of children living in nursing homes

To reduce the number of children who live in nursing homes, officials and advocates agree, Oregon must redirect the flow of dollars paying for their care.

That means untangling a kink in Medicaid, the federal-state health insurance plan for low-income people.

All 83 of the severely disabled children who live in four Oregon nursing homes are covered by Medicaid. The state reimburses the nursing home about $275 a day per child. That covers about three-quarters of the full cost of care, which reaches $125,000 a year.

Advocates for such children and their families say the state could keep more children at home -- and save tax dollars -- by seeking a waiver from federal Medicaid rules. Those rules backfire, they say, by covering a disabled child placed in a nursing home when the same child would not necessarily be covered at home.

James Toews, the Department of Human Services official in charge of programs for people with disabilities, says a Medicaid waiver would lower the number of children in nursing homes. He hopes to submit a waiver for federal approval by year's end.

But he says it's "not realistic" to assume every child can live at home, because these children have complex medical needs and families vary in their ability -- physically, emotionally and financially -- to take on that challenge.

And he doubts the waiver would save the state money. If Oregon secured a waiver and Medicaid started covering in-home care for non-poor families, demand would increase sharply. The Legislature would decide how much money to spend.

Nursing homes say some children still would require their care.

"One size does not fit all," says Greg Dempsey, administrator of the Rest Harbor home in Gresham, which has 10 licensed pediatric beds among its 128 total. "I can tell you, having been in this business 30 years, there will always be a niche for us."

The goal is always to discharge a child to a less-intense level of care, such as a group or foster home, he says. "But some of these cases have medical issues that I'm not sure can be handled in foster care."

Medical foster care homes are "very few and far between for children with these needs," says Kim Wells, administrator of the Marquis at Mount Tabor home, which has up to 12 beds for children.

Rep. Sara Gelser, D-Corvallis, proposes a Medicaid waiver covering as many as 125 severely disabled children, including some of those currently in nursing homes.

Gelser sees the Center for Medically Fragile Children at Providence Child Center evolving into a new role. Instead of a residence for children, it would provide rehabilitation and short-term respite care for families.

Gelser says it's not only less expensive for the state but better for the children to care for them at home. In her view, it's not possible for a large institution to duplicate a family environment.

"No matter how well-meaning," she says, "it's not the same as being at home, with the big sloppy dog licking your face and your brother offering you a lick of his ice cream cone, even if you can't lick."