Which Medicaid waiver do you object to?

By Richard Malaby, Special to the BDN
Posted Sept. 11, 2012, at 3:12 p.m.

At the end of the last session, the Maine Legislature passed a budget virtually along party lines that would roll back some eligibility requirements for MaineCare to the federal minimum. The Legislature also eliminated some redundancy regarding those who are eligible for both Medicare and Medicaid. Finally, Maine eliminated eligibility for childless adults aged 19 and 20, as has most every other state.

Such changes will require a waiver from the secretary of Health and Human Services, Kathleen Sebelius, as the actions undertaken seemingly violate provisions of the Affordable Care Act, which prohibits such Medicaid rollbacks by the states.

Gov. Paul LePage has written a letter to Sebelius requesting a rapid decision, as the state budget for fiscal year 2013 is contingent on an affirmative rapid decision. Recently, Maine Attorney General William Schneider petitioned the U.S. 1st District Court of Appeals to approve the MaineCare changes requested by the state. The governor’s intent in requesting this waiver is clear: We must roll back some eligibility and benefits so we can better serve the most needy among us.

Regardless of how one feels about the likelihood of the success of this waiver request, this is not the waiver about which I am most concerned. I am concerned about the waivers we have received for caring for our adults with developmental disabilities and those who have suffered traumatic brain injuries. Federal Social Security Law requires that we provide adequate and appropriate housing, shelter and services for these individuals. We have received waivers to allow us to house these individuals in group homes and shared living arrangements, with appropriate and often adaptive services and community supports, but we have never fully funded these investments. We are clearly in violation of federal law.

Currently, Maine has 717 developmentally disabled adults on a waiting list for Section 21 supports and housing. Of these severely disabled individuals, 185 are categorized as Priority 1, which means they will require substantial investments in their housing and services, often costing well in excess of $200,000 per year for life. There are another 532 individuals waiting for housing and supports who have lesser needs, but again the state does not have the funds to fulfill our legal requirement to take care of their health and welfare.

Some of the individuals on our Section 21 waiting list are also on the Section 29 waiting list, which means they are also eligible for community supports, more commonly known as a day program.

In Hancock County, Downeast Horizons operates such a program. These developmentally disabled individuals receive skills development, and such a program provides a de facto respite for their families. Providing a day program can be the advantage that keeps an individual from slipping into a Section 21 waiting list, where their needs become more intense and expensive. Often, day programming can be achieved for about 10 percent of the cost of Priority 1 Section 21 individuals.

I have been a legislator for 90 weeks, and I have yet to go through a week in which some parent, teacher, educator or grandparent has not called me to ask for my help placing a developmentally disabled friend or family member into some level of services. And I usually fail in this request because we just don’t have the money.

So when you read about the governor’s request for a waiver so we can roll back eligibility for 19- and 20-year-olds, so that we can roll back eligibility and benefits for our MaineCare population to the national average, think about those on the waiting lists. Think about those we are legally obligated to support but do not. Think about those who are developmentally disabled or have traumatic brain injuries. These are the truly needy.

State Rep. Richard Malaby, R-Hancock, serves on the Health and Human Resources Committee.

http://bangordailynews.com/2012/09/11/opinion/contributors/which-medicaid-waiver-do-you-object-to/ printed on September 16, 2014