Nurses and social workers who provide health services to hundreds of Howard County's most vulnerable residents will lose their jobs under new Medicaid rules, local officials say.
The new rules will mean the loss of $701,000 annually to the county and the elimination of 13 case managers who visit and arrange health services for low-income residents, said Dr. Peter L. Beilenson, Howard's health officer.
"It affects from the very youngest to the very old," Beilenson said.
In addition, the county's Citizen Services Department, which includes the Office on Aging, will lose another $700,000 a year, director Susan Rosenbaum said. That money pays for eight nurses/social workers and helps 214 nursing-home-eligible people stay in less expensive assisted-living facilities. More than 700 elderly county residents are on a waiting list for those services, she said.
"For us, it's a system that works really well," Rosenbaum said. "These are highly trained, skilled people. We're really worried about the impact."
Federal officials defended the changes, which take effect tomorrow, saying they will eliminate payments to states for unauthorized services while giving clients the ability to chose service providers.
"In general, these regulations are very beneficiary-centered, and they provide things like freedom of choice of the provider," said Dennis G. Smith, director of the Center for Medicaid and State Operations for Medicare and Medicaid. "If the state does not provide that currently, they will need to do that."
Nationally, spending for the program - called Targeted Case Management - increased 76 percent from 1999 to 2003, from $1.7 billion to $3 billion, according to federal statistics.
The changes, which affect all states, will have a similar impact across Maryland, said Sen. Barbara A. Mikulski. About 200,000 people could lose services, and 1,400 workers could lose their jobs, she said.
Mikulski and Sen. Benjamin L. Cardin helped sponsor legislation approved by the Senate on Monday to delay the changes until April 2009 in the hope that a new president might scuttle them. The House will consider the amendment.
"This bipartisan amendment stands up for thousands and thousands of people all over the United States who are about to lose their social workers or their nurses because of a new, harsh punitive rule," Mikulski said Tuesday in a statement.
In a letter to Mikulski, County Executive Ken Ulman said that complying with the new rules "could require that Maryland fragment access to home and community-based services," which he said is "in direct opposition to other current federal and state initiatives for long-term care reform."
John G. Folkemer, deputy state health secretary, told a General Assembly committee that the loss to Maryland could total $75 million a year.
State officials are scheduled to meet with federal administrators in early April to discuss the timing of the rule changes, he said, and it might take a year or more to affect seniors in assisted living.
"We're still very upset," Folkemer said. "We may have a little more time to figure out what to do. We still have the problems. We have to come into compliance or end the programs."
In testimony before the House Health and Government Operations Committee on Feb. 1, Folkemer said that "every single program we have in the state is out of compliance with these new regulations."
He said the new rules will apply much more broadly and require the state to allow clients to choose from among public and private services instead of having centralized, government-run agencies provide case management.
"We'd have to open it up to anybody, and there'd be no monitoring," he said.
But Smith said the new rules, which are based on the Deficit Reduction Act of 2005, will not eliminate oversight.
"If you think the rules are too restrictive, tell us why. It's not productive to say, 'We don't like it,'" he said. "For the individual [client], this should have no impact whatsoever. We want them to get good case management. I'm very passionate that the individuals are the ones who are gaining from our rules."