Tag Archives: care for elderly and disabled

Alabama Legislators Want “Blood on the Floor”: Especially the Blood of Children and Grandparents

Well. I heard from a very credible source yesterday that our state legislators are not playing chicken with the budget this time. You know, it seems like every year they expect us to display panic and beg them to fund essential programs– it is so predictable it is almost like we have a set script. We get tired of it, but at the same time we think jeez, if we don’t play our assigned role, maybe they will do the bad thing.

This year may be different, if my source is correct. Their plan this time is to go ahead and pass a severely cut budget, which the governor will refuse to sign, and then override him. Then when there is “blood on the floor” (and I quote), they expect us to come screaming to them to pass taxes and re-fund the state. They do not feel they have support from their base, otherwise.

I don’t know. From my perspective, we already have blood on the floor. People in this state have been bleeding all over the floor for a long time, and it hasn’t mattered so far as the budget. The only blood I think the legislators care about is corporate blood and their own, so maybe the point is that business will begin fleeing the state once Medicaid is defunct and all the people in nursing homes have to move in with their families or be dumped on the street.

Getting even a level budget for mental health would not be a win, because there is major blood on the floor with our current budget. Getting the expected cut to Medicaid ($320 million, taking the federal match into account) would make the floor downright slippery. The cuts to doctors will be so sharp, around 40% cut to payments already well below private insurance rates, that I have personally heard several pediatricians say their plan would be to immediately drop Medicaid. Most practices have overhead in the range of 60 to 75%, so that 40% is at least the entire salary of the physician. There will not be enough of us left to see those suddenly doctor-less kids, even if we worked 24-7 without sleep. The 2 Children’s hospitals will close, because they depend on Medicaid money to fund their specialists. And good luck trying to get programs like that rebuilt to their current level of excellence, once they are gone. It takes decades.

Who will be affected first? The elderly in nursing homes. Children (guess they should take more personal responsibility). Because people of color are disproportionately affected by poverty, this is also a racist move. Some advocates are making a case by reminding legislators and voters that middle class elderly are in nursing homes using Medicaid funds, and that there are more poor white kids than black ones. Why should that even be said, as if poor elderly and black kids matter less? Only a racist and classist audience would need to be told such things.

I asked it there is anything at all we can do to stop this disaster, and my source told me we need to call our legislators. I’m going to add that you really need to talk to your neighbors, co-workers, etc and explain what is about to happen. Because legislators have told me previously that although phone and email contacts matter, they also use their in-house polling results, which are secret. They call their base on a regular basis to check in, and I am betting they are getting the no new taxes response from those voters.

If our legislators were ethical, they would be calling those voters not to ask their opinion but to persuade them– they would be pulling out the stops to stop the bleeding. They would stop putting forward bills that they know will cause us to waste tons of money defending federal lawsuits. The fact that they aren’t doing so says a lot.

I remember the last time this type of cut was proposed, and the legislators came up with a Hail Mary to borrow money for Medicaid– I had prominent progressive friends telling me that I was just playing the game by begging for votes to save the program– that I should let things play out, let the blood flow, call their bluff. So it isn’t just conservatives who are the problem. I do not believe an ethical person who understands these are not numbers– they are human beings– would promote such an idea. We all have our preferred ideas of where the funds should come from, and y’all, we do not have strength in numbers to bicker over that right now. If we do, we will surely lose the farm. I can say that a lottery would come too late and is not a solution for the current funding gap, which could begin as early as June. Otherwise, I’d support whatever taxes they are willing to pass, even though I’d prefer to stop corporate subsidies first.

My source says the fed will not likely permit our Medicaid program to be cut so much without responding. We could be taken into some kind of Medicaid custody. But… the kicker is that they can’t MAKE us write a check, so this is different from school integration. They can put key decision-makers in jail, they can withhold federal funding as leverage, but they can’t issue money from the state, raise our taxes for us, etc.

All that said, I would still call your legislators. I would tell them that level funding is not enough for mental health and that it is killing people as we speak, because of waiting times. And if you happen to have a job opportunity out of state, you might want to strongly consider it, especially if you have children. I’m going to stay as long as I can, but I do have a disabled adult family member who depends on both Medicaid and me, so there will be a limit. I don’t know how long my employer will be able to keep me, if well over my entire salary is defunded. Feel free to share all or part of this post if you think it will help.


Filed under Alabama Legislative Session 2015, Alabama Politics, Children's Issues, Medicaid

Patient Protection and Affordable Care Act Part 7

Really interesting section today– pp 461-487.  This is all about long term care, and I think addressing the poor quality/ availability of long term care for our elderly and those with disabilities is long, long overdue.  So far this is one of the best sections I’ve seen.   I have only 2 real concerns– first, is the extra money being provided going to be sufficient to pay for this and second, why can’t we have this for everyone?  I am very pleased if it means a decent level of services for the poor, but if we had universal single payer insurance,  ALL of our parents, grandparents, children with disabilities, etc, could have access to good quality care!    HR 676, the Conyers bill, would provide this for all of us.

With that in mind, let’s get to the good stuff.  There will be an option for states to provide long term services and supports.  That doesn’t mean they have to, but that they can– if they do, their FMAP will increase by 6%.  It starts October 1, 2010.  What could happen is that people needing long term care (including those with mental illnesses, awesome!) who make no more than 150% of the poverty level can choose to have home and community based services instead of institutional care.  They only qualify for this IF they would otherwise have to be in an institution.  It sounds like this is mainly paying for human assistance– home health nurses, aides, etc– and not so much for equipment.  However, there will be some money “transitioning ” to home/ community care, like rent and utility deposits, bedding and kitchen supplies, and equipment that would make it possible to provide less human worker time (beepers are specifically mentioned).  They are not going to pay for room and board, special education/ vocational rehab, assistive technology, medical supplies or home modifications (that doesn’t mean the person couldn’t apply for help with those through another program).  I’m a little confused about how the equipment, like beepers mentioned above, is different from assistive technology– we may have some issues figuring out what belongs in each category.

In order for the state to qualify for funding, it must arrange collaboration with an advisory council– and the majority of members must be those who are disabled, elderly, or their personal representatives.  The services will be “consumer” controlled and there must be processes for mandatory reporting of problems/ abuse. 

The people who get services will have assistance with what is called “activities of daily living” (ADL).  This includes eating, toileting, grooming, dressing, bathing, and transferring from beds to chairs, etc.  There are additional provisions for meal planning, shopping, managing finances, chores, communication (like phones), and traveling to participate in the community activities.  It really does sound comprehensive.

States will have an option of adding people making up to 300% of the maximum Social Security Benefits and other undefined “special populations”.   The program has to be comparable across the whole state.  There is a section titled “Protection against spousal impoverishment”  but it is very short and never mentions spouses, so I’m not sure what it means!

Finally, there is a very poignant section describing the plight of the elderly in our country.  It’s the most readable section I’ve found yet and actually sounds compassionate.  The “Sense of the Senate” is that the 111th session of Congress should specifically address long term care for the elderly, in a truly comprehensive way, including efforts to make GOOD community care available to everyone.  So this tells me Congress can be compassionate, and don’t give me all that stuff about the AARP lobby, which I already know– let me have my optimism!  If they can be compassionate for our grandparents, maybe we can eventually help them be compassionate for us all.


Filed under Healthcare reform, Uncategorized