Medicaid cuts viewed as distasteful but not ousting nursing home elderly


ANNAPOLIS -- No one in a nursing home will be forced onto the streets by a cut in Medicaid funding for long-term care, but the cut still appears inevitable, the state health secretary said yesterday.

"We will not allow anyone in a nursing home to be abandoned," Secretary of Health and Mental Hygiene Nelson J. Sabatini said at an informational meeting with legislators and those who work with the elderly. "But there's nothing [else to cut] that would be less distasteful or onerous."

Mr. Sabatini's department must pare its budget by $65 million to help the state cover a projected $450 million shortfall for fiscal 1993.

Approximately $7.3 million of that amount would come from changing Medicaid eligibility requirements.

The cut affects about 2,000 nursing home patients who qualified for Medicaid after exhausting the bulk of their savings.

Under the new regulation, you are not entitled to Medicaid if your income is more than $1,075 a month.

Currently there is no income limit, and when a patient's income falls short of a nursing home's fees, the state covers the gap.

Nationwide, 27 states help to cover the gaps, while the others have income limits for nursing home patients who wish to go on Medicaid.

But most of those states with income limits, according to information compiled a year ago, have higher income ceilings than that proposed for Maryland.

If Maryland adopted the more typical monthly income cap of $1,221, the difference would be significant in some cases. The National Lutheran Home in Rockville, for example, has 25 patients who would be without Medicaid coverage under Maryland's proposal. That number would drop to five under a limit of $1,221.

Throughout the state, most of those affected by the change are middle-class patients in suburban nursing homes, whose Social Security checks and pensions put them over an income limit of $1,075. Yet the average rate of $3,000 a month in private nursing homes is well beyond their means.

"These are not wealthy people," said state Sen. Paula C. Hollinger, a Baltimore County Democrat on the legislative committee that must approve the change. "You have removed the safety net from under them."

Mr. Sabatini held out the possibility that nursing home patients already on Medicaid might remain under the existing eligibility requirements. Or a bad debt pool could be set up to cover them, although that could cost almost as much as the $7.3 million saved by the change.

Whatever happens, he said, the state will not write the regulations necessary to change the Medicaid program until plans have been made for those already in nursing homes.

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