County Executive Maggie Brooks wants to straighten out the county budget, but to do so she will have to take a closer look at some of the figures she's using. If not, she may find herself wondering why an estimated $500 million in state savings never materialized.
Hoping to bolster state coffers through Medicaid reform, Brooks endorses a plan to bring the program's financing under control. One of the plan's details, which seeks to cut the number of hours of personal care to which a Medicaid beneficiary is entitled, has created controversy.
Not only do disability-rights activists say it's a bad idea, but the amount of money Brooks said the state would save is inaccurate. In fact, the savings figure she recently presented is more than double the amount shown by the very source of the reform plan she advocates.
The confusion began with a letter printed April 12 in Albany's Legislative Gazette, which Brooks co-signed along with Rochester Business Alliance CEO Thomas Mooney, county executives from Erie and Onondaga Counties, and other businessmen from the region.
The letter lays out a four-point plan intended to relieve local taxpayers from some of Medicaid's enormous financial obligations. The program, which pays for health services for the poor, elderly, and disabled, receives 25 percent of its funding from county governments. And it's considered by many to be unduly burdensome on state and local budgets.
The letter partially relies on a report issued by the New York Citizens Budget Commission (NYCBC), a nonprofit civic organization, to argue the financial benefits of reforming Medicaid.
What has enraged many Medicaid proponents is the last point listed in the plan, which suggests cutting the number of hours of personalized care a Medicaid recipient is entitled by half.
"These costs, and home attendant services, such as housekeeping and shopping, need to be reviewed and adjusted," the letter states. "Reducing the average number of hours of personalized care for authorized clients from 30 to 15 hours would move New York's personal care costs in line with national norms. We need to provide adequate coverage to Medicaid recipients, yet not extravagant compared to other states. Estimated Savings Statewide: $1 billion."
The source of this figure, according to the letter, is the NYCBC.
But the NYCBC says no such thing. The group's report on Medicaid reform, released in February and entitled "Confronting The Tradeoffs In Medicaid Cost Containment," actually estimates statewide savings from reduced personal care hours to be $416 million --- a hefty sum, but nowhere near the $1 billion cited by Brooks and company.
The $1 billion savings is actually a reference to the $1.04 billion of combined federal, state, and local savings the report approximates. The vast majority of the savings --- $520 million --- would go to the federal government, and the remaining $104 million would go to New York's counties.
When asked to clarify the figures presented in the Albany letter, Monroe County Director of Communications Larry Staub acknowledged that the savings would not be statewide.
"I believe the amount referenced is the total estimated savings --- state, local, and federal --- that would be achieved if this proposal were adopted in New York State," he says.
The suggestion to reduce hours has drawn the ire of Medicaid's supporters, including Chris Hilderbrant, the director of advocacy at the Center for Disability Rights (CDR), who argues that the report's logic is flawed.
"Even those savings numbers [projected in the report] are questionable because they have been calculated devoid of any consequences," he states in a letter issued to Brooks on April 15. "When our people have less than adequate services, they will have more health problems. This will result in greater frequency and duration of hospitalization and in some cases will result in placement in a nursing facility."
He considers several of the suggestions in Brooks' letter to be "questionable," but is particularly incensed by the idea of cutting the number of hours of personalized home care.
"That can't happen in any way, shape, or form," he said in a telephone interview last week.
The result of such a move, Hilderbrant says, would actually be an increase to the cost of care for Monroe County and New York State, as Medicaid patients would find themselves requiring hospitalization and other more expensive services. The CDR supports Medicaid reform, Hilderbrant says, but not the reduction of hours of personal care.
"Why would you take money from programs that create jobs for people who would otherwise be unemployed?" Hilderbrant says in his letter. "Our agency alone employs over 400 attendants through the personal care option. Many of these people would otherwise be seeking public assistance. Our community wants an explanation."
Medicaid's critics, however, do not agree. They say the number of hours of home care paid for by Medicaid in New York State averages 30 hours a week for about 69,000 clients, compared with the national average of 11 hours a week. The NYCBC report recommends the state cut the hours to an average of 17 a week. In addition, New York State pays an average of $7,412 for personal care per beneficiary, compared with the national average of $2,079 per beneficiary.
The letter was the second time in two weeks Brooks took a public jab at Medicaid.
When she appeared before the county legislature last week, she pressed the lawmakers to join her in an effort to wipe out the projected $25-million budget deficit by the end of the year, and to do it without raising taxes or cutting services.
"We need to be creative, we need to think outside of the box, and we need to govern like we've never governed before," she said, adding that she and the lawmakers must hold to the resolution to not "tax our way out of the deficit."
One of the root causes of the deficit, she said, is the county's obligation to state-mandated programs like Medicaid.
"In fact, over 80 percent, or $20 million, of the projected deficit is directly attributed to Medicaid, mandated changes to social services, and other state-initiated adjustments," Brooks said.
Of all personal care recipients in the state, 78 percent of them live in New York City, and their care accounts for 85 percent of the program's spending, the NYCBC report says.
The plan outlined in the Albany letter suggests three other points of Medicaid reform in addition to the reduction of personal-care hours.
First, in order to avoid raising property taxes in the coming years, Brooks and her fellow reformers hope, through legislation pending in Albany, to cap local Medicaid expenses at the level of the 2003-2004 state fiscal year. Second, Brooks hopes to expand the number of Medicaid clients in managed care, which she argues is more cost-effective. Finally, she proposes Medicaid use preferred drug lists to reduce pharmaceutical costs.
Coincidentally, the combined estimated savings of these three proposals is roughly $1.04 billion.
"The bottom line is to control costs without impacting medical care," Staub said.
Still, Hilderbrant and the CDR are not swayed. They say Brooks has betrayed a commitment to work with the group on issues affecting the disabled, such as Medicaid. The group had a positive and productive meeting with Brooks in January, Hilderbrant says, and assumed it had a good working relationship with the Office of the County Executive.
On Wednesday, April 21, the CDR led a protest at Brooks' county office on West Main Street. As a result of the protest, the group has been granted a meeting with Assistant County Executive Jerry J. Helfer, scheduled for April 30, Hilderbrant says.