Legislative actions produce mixed results for home- and community-based health care

Legislative actions produce mixed results for home- and community-based health care

The Indiana General Assembly has taken a number of actions over the years to improve home health care services in Indiana. In 1987, the CHOICE home care law was passed, and in the mid 1990s, the statute was amended to enhance the rights of persons with disabilities and to expand the application of its cost-sharing provisions so more middle class Hoosiers could afford home care services.

Other bills passed include:

Assisted Living and Adult Foster Care -- The 2000 legislature passed House Enrolled Act 1197, drafted by CAC for the Task Force and authored by State Rep. Peggy Welch, D-Bloomington, that directed the state's Family and Social Services Administration (FSSA) to apply to the federal Health Care Financing Administration for permission to establish Medicaid waiver funding in Indiana for assisted living, adult foster care and expanded adult day care services.

Those new public services should have all come on line July 1, but they have not. The assisted-living Medicaid waiver will not become effective until Oct. 1, if then, and the effective date of the adult foster care waiver is still up in the air. FSSA claims the legal barriers blocking the implementation of the adult foster care waiver have not been fully resolved at this time. And past cuts in state agency staffing levels have clearly hampered the state's ability to implement these new services.

However, it also appears that FSSA has been under pressure from the Governor's office and the State Budget Agency to delay the implementation of these new Medicaid waiver services in order to save money. For low income Hoosiers who need assisted living and adult foster care services to stay out of nursing homes, the failure of the administration to implement these badly needed long-term care options has been, and remains, unacceptably slow.

House Enrolled Act 1767 -- This legislation, authored by State Rep. Jeff Espich, R-Uniondale, was based on policy concepts presented to Espich by CAC on behalf of the Task Force. It passed the General Assembly during the 2001 session without a single opposition vote.

The legislation requires FSSA to present a plan to the General Assembly "to assure that services provided to eligible individuals match the needs of those individuals as closely as possible" for the entire "continuum of (long term) care" and that the "projected costs for providing services to all eligible individuals through the continuum of care (be) compared with projected costs for serving all eligible individuals in an institutional setting."

This bill, which had strong support from Rep. Pat Bauer, the South Bend Democrat who chairs the Ways and Means Committee, was a clear directive from the legislature for a blueprint from FSSA for a plan to meet all of the long-term care needs of the citizens of Indiana. Unfortunately, as of this writing, there has been no evidence that FSSA has done anything to develop the data and recommendations required by this law. The act requires FSSA to issue preliminary findings no later than Sept. 30, 2001.

House Enrolled Act 1001, the State Budget Bill -- The state budget law appropriates funding for virtually all state and federally funded public programs in Indiana. In the 2001 General Assembly, the original version of the budget bill, which was prepared by the O'Bannon administration, contained no increases in funding for the CHOICE home care program.

However, an amendment by Rep. Bauer, the bill's author and Ways and Means Committee chair, changed that. He amended the bill in his committee to increase CHOICE funding by $12 million for the two-year budget that started July 1 and to increase funding for home care workers by $6 million over the same period. (Late in the legislative session, Governor O'Bannon publicly endorsed increasing CHOICE funding by $15 million, but the General Assembly did not act on his recommendation.)

During House-Senate negotiations over the budget bill, attempts by State Sen. Robert Meeks, R-LaGrange, to cut funding for home health care services were effectively rejected by Rep. Bauer and State Sen. Vi Simpson, D-Bloomington. In its final version, the budget act appropriated a total of $97.4 million for the CHOICE program.

Unfortunately, of the $12 million in new CHOICE funds that were appropriated in HEA 1001, the O'Bannon administration has decided to address its fears of a budget shortfall by not spending $1 million per year of those monies, and by withholding its decision on how to spend another $2 million per year in CHOICE funds. The administration has been able to do this because of a clause added to the budget act at the insistence of Sen. Meeks.

The failure to spend money appropriated for the CHOICE program is shortsighted at best, according to the Indiana Home Care Task Force. In a statement released on July 25, the Task Force said: "The one million dollars in cuts slated for the CHOICE home care program will only serve to drive more people into premature nursing home placements (at a greater cost to taxpayers and the state) and/or premature death."

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