Cona: Medicaid cuts will impoverish elderly

Gov. Andrew M. Cuomo came out of the gate swinging in January when he announced a bold plan to reduce Medicaid spending in New York State. He created a redesign team to find ways to cut costs and cap the state's Medicaid expenditures. While we can all agree that the system is broken, balancing the state budget on the backs of the frail elderly, disabled and most vulnerable members of our community should not be tolerated.

Two of the redesign team's proposals are especially alarming for our senior citizens on Long Island. First, the team proposes to eliminate "spousal refusal." This has long acted to protect husbands or wives from becoming impoverished when their spouse requires long-term health care. On Long Island, where the average cost of care can be tens of thousands of dollars per month, a family's assets can be very quickly depleted. By employing spousal refusal, spouses who are not receiving health care are allowed to retain assets in excess of the amount proscribed by the state -- and therefore can avoid becoming destitute themselves.

The logic is clear: We don't want two spouses on government benefits -- one on Medicaid due to a health care crisis and one on food stamps and Supplemental Security Income because that crisis wiped the couple out. But if spousal refusal is eliminated in the state, that is exactly what will happen. All that will be accomplished is the shifting of people from the Medicaid rolls to the roster of other government benefit programs.

Second, the redesign team proposes to apply the same 5-year look-back period for people seeking Medicaid benefits for nursing home care to those who wish to receive home care or adult day care. Currently, there's no look-back period for individuals applying for such community-based Medicaid benefits. Upon proving financial eligibility (that is, total assets below the current state limit), an applicant can begin receiving these benefits immediately, without going through the arduous -- and sometimes impossible -- task of producing five years of bank records and providing an audit trail for every transaction over $2,000 during that period.

Consider people with Alzheimer's disease. Their children may have no idea where they maintained bank accounts and most certainly would be unable to explain what mom did with that $3,000 back in 2007. But that is exactly what would be required for them to get the in-home care if the look-back is imposed for community Medicaid benefits.

Home care has helped many seniors remain in their homes. Families make it work by using seniors' income to contribute toward the cost of their care, and relying on family members as caregivers to fill in the gaps in hours or services provided by the Medicaid program. Imposing a 5-year look-back for these benefits will ultimately push more people into nursing homes -- into care that is far more costly to the state than caring for the elderly at home -- because if they have to go through this onerous process anyway, some families will opt for nursing home care instead.

I have yet to meet a senior who wants to go to a nursing home. Shouldn't government help citizens remain at home with sufficient support?

One of the problems with the governor's Medicaid redesign team is its composition. The only home health care provider is a major conglomerate. There are no nursing homeowners or administrators, and not a single elder-law attorney on the team. These service providers are on the front lines of the battle to help the elderly and disabled get the care they need in the face of shrinking dollars. They see firsthand how Medicaid affects the care clients and their families are able to access. Shouldn't their voices be heard?

The solution may well be expanding access to government-supplemented in-home programs, where the cost of care is far less, and even expanding the government's support of assisted-living programs for the same reason. Government's role should be to help elderly citizens gain access to the care they need, not to impoverish them.