Proposals to save money in the state's Medicaid budget brought opponents out in force Monday.
Last year, to help handle its budget crisis, the state cut two and a half percent from the rates it pays doctors, hospitals, and other Medicaid providers. This year, it's proposed a series of additional savings, including limiting home health services for individuals to 240 hours per year. The Department of Health and Human Services estimates that could save more than $3.5 million dollars.
But in a news conference before a hearing on the proposals, Dr. Bob Rauner of the Nebraska Medical Association said limiting home health services could cost more than it saves. Rauner gave the example of a patient with a chronic wound. "You may need to have this seen every couple of days, every week. If you suddenly cut that access off, that patient is instead going to end up in an emergency room or a hospital where they need an amputation, and so some of these cuts are not going to achieve the savings they are hoping to get," he said.
In the hearing, Director of Health and Human Services Kerry Winterer said three neighboring states have the same or tighter limits. Winterer denied that limiting home health services would cost more. "There has been concern expressed that this will result in institutional care. This is not the case," he said. "We believe it is important for people to stay at home and have in fact developed programs for that purpose. Appropriate care for clients can be provided through the home and community based waivers and personal assistance services. The hourly rate of those services are about half the rate of home health services." The waiver Winterer referred to allows Medicaid to reimburse family members, rather than home health aides, to do things including caring for wounds and giving injections.
Beyond resisting the proposed cuts, Medicaid providers want the Legislature to restore the 2.5 percent cut last year. John Cavanaugh of Building Bright Futures, a child advocacy organization in Omaha, said that would cost the state $28 million, and bring in another $40 million in federal matching funds.
The proposals come at a time when Gov. Dave Heineman has proposed cutting taxes by $327 million over the next three years. In his State of the State speech, Heineman anticipated opposition to his proposal from people who want the state to spend more. "Special interest groups will argue that we can't afford tax relief because they want to take that money from our hardworking taxpayers and spend it on their favorite projects."
But Topher Hansen of CenterPointe, a Lincoln substance abuse and mental health treatment program that relies on Medicaid, argued with that perspective. "Our citizens stand equal. Our ethic is to help the person next to us, not call them a special interest because they need help."
Legislative committees have not yet acted on either the proposed Medicaid changes or the tax changes.