Speakout: Clients are key to Medicaid solution
April 25, 2005

By Julie Reiskin, Special to the News

In its editorial of April 15, "Drug list a step toward cost savings," the News stated that a Medicaid preferred-drug list is a good first step for needed reforms, then listed many of the reasons not to engage in such a risky proposal.

Medicaid is one of the few social programs whose good is indisputable. The existence of the Medicaid program, particularly the home and community based services programs, is a literal lifeline for me and many other members of the Colorado Cross-Disability Coalition. As volunteers we assist other Medicaid clients with knowing the rules, making the best choices and providing advocacy when the system does not work. We also work closely with the state agency that administers Medicaid and any legislator willing to listen.

Often, when the powers that be discuss Medicaid reform, the one group that could be most helpful in fixing systemic problems is not invited to the table - Medicaid clients. We live with the system and are the most invested in making the system work over the long haul. Any change in a system so large and entrenched is difficult and controversial. Nothing fills a Joint Budget Committee hearing room faster than a discussion of the Medicaid budget.

Fortunately, the current Medicaid director and Gov. Bill Owens have been receptive to hearing from Medicaid clients and we have seen some of our ideas implemented. All of our proposals have made the program more effective and have saved tax dollars without taking services away or cutting rates.

Two great examples of client-proposed solutions are the Consumer Directed Attendant Support Program and the Nursing Home Transition Program.

CDAS is simple. In lieu of receiving home-based services from a certified home health or personal care agency, clients are given the dollars the state would have spent to hire our own help. We must spend the money on our care but can use half of any savings to purchase items to assist us with independent living, such as a backup wheelchair or an adapted computer.

The funds go in an account and we submit employee information, time sheets and rates of pay. We must stay within our allocated budget. Studies in other states, and our own anecdotal experiences, show that this is not only cost-effective, but also produces higher quality care and better overall health.

We are able to pay the direct workers more at less cost to the state by eliminating what is sometimes the 50 percent overhead of an agency. The only problem with this program is that it is currently limited to clients able to do the direction ourselves. Expanding the program to serve anyone with long-term care needs and allowing them to use a volunteer proxy, such as a family member or friend, would save even more money.

The NFT is a program designed and run by our 10 certified centers for independent living. According to data submitted by the nursing facilities to the federal government, there are more than 2,000 Colorado citizens in nursing facilities that could live in the community. The NFT provides peers who have made the leap from institutionalization to independence as a way of presenting options to current nursing facility residents. Staff members also are available to coordinate services for residents who want to leave a facility. In addition, a small amount of money is available to assist clients with purchasing kitchenware, basic furnishing, etc. Nursing facility clients are allowed to keep only $50 a month, so they cannot save for an apartment.

Programs like these will be the way we will make this program manageable financially. It is true that the disabled and elderly consume most of the dollars, and this makes sense because we have the greatest need. Trying to slap arbitrary restrictions like drug formularies, or commercial solutions such as forced managed care has shown to be not only ineffective, but also more costly in the long run.

We are not similar in any way to the commercial population. If the traditional commercial model worked for us, there would not be a need for Medicaid.

However, the real solutions that will benefit clients will take continued political will. Our ideas pose a great threat to the service industry, which has controlled not only Medicaid dollars, but also our lives for years, to relinquish that control. Programs like CDAS around the country have proved beyond a shadow of a doubt that we know what we need and can meet those needs in the most cost-effective fashion.

If we can get back to Congress' intent for the Medicaid program by involving clients at all levels of policy-making and allowing us to take responsibility for controlling the resource, we can solve this crisis.

Julie Reiskin is the executive director of the Colorado Cross-Disability Coalition.

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