Maryland has a huge backlog on Medicaid home care. Some patients die waiting.

More than 11,600 Maryland elderly and disabled people with Medicaid have been waiting for help at home for a year. Some are hospitalized, institutionalized or even die in the process.

These medically vulnerable residents who need help with tasks like bathing, dressing, cooking, cleaning and running errands are part of a huge backlog of home care applicants through Medicaid, the state-administered public health insurance program for low-income people. The Maryland Department of Health has just eight workers to process applications.

Family members with their own work and family obligations must step in and often cannot provide the level or frequency of care their loved ones need. Caregivers often face overwhelming stress as the dignity, well-being and safety of their family members are compromised.

Adding to their stress, family caregivers often have to navigate an opaque and complicated process to get an application approved for Medicaid home and community services. Many report having to make hundreds of phone calls, send hundreds of emails, and submit countless documents, all the while receiving conflicting or inaccurate information from the state and other agencies.

Rona Battle contracted COVID in a nursing home around June 2020, her sister Jayne Felton said, during a brief rehabilitation stay after a fall. Battle, then 55, suffers from high blood pressure and diabetes and was cycling in and out of hospital with COVID-related complications.

At one point she was placed on a fan, and subsequently she needed a tracheostomy in which doctors cut a hole and inserted a tube into her neck to help her breathe. Felton said her sister, who was discharged to a nursing home in Anne Arundel County, was unable to speak for about a year, but once she started to feel better she expressed how much she wished she could live alone again.

Battle doesn’t like not being in control of his own life, Felton said, who spoke to The Banner about her sisters behalf. She felt that her privacy and independence were compromised.

Battle had been enrolled in Medicaid long-term care coverage when she was admitted to the nursing home, and Felton applied for the Home and Community-Based Services program in March 2022. In May of this year, thanks to persistence of Felton and countless hours of effort, it was finally approved.

The Maryland Department of Health said it is working to clear the backlog. In May, the department told disability advocates it was actively initiating efforts to contract with an outside agency to process applications. and take responsibility for making plans on a permanent basis. The agency outlined further plans to make the systems more efficient in the long term.

Chase Cook, interim director of communications, said there are nine open positions for clinical and non-clinical applications reviewers. Base salaries for these jobs will soon rise from $3,000 to $5,000 a year in an effort to recruit more candidates.

A bureaucratic nightmare

Medicaid is the nation’s largest payer of long-term care. Medicare, the public insurance program for people age 65 and older, does not cover long-term care. Private long-term care policies aren’t bound by laws that protect people from being denied coverage based on pre-existing conditions, so they must be purchased while a person is still in good health and will pay increasing premiums for benefits that may never be paid. used.

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Without that coverage, people in need of long-term care have to pay out of pocket, which will often deplete them in short order, at which point they’ll apply for Medicaid.

In recent decades, research on long-term care, as well as public preferences, have come to favor home and community services over home care wherever possible. Home care allows people to move out of institutional settings to age in place in the comfort of their own homes, where they enjoy greater self-determination and a stronger sense of well-being.

An AARP survey conducted in 2021 found that 77 percent of adults ages 50 and older want to stay home as they age. Home and community-based services are also significantly less expensive than home-based care, which saves state and federal Medicaid funds.

Maryland has three Medicaid programs targeting older adults and adults with disabilities, tiered according to the level of care needed. Battle applied to one called a community options program, which provides the highest level of assistance to beneficiaries with the greatest needs.

During her interview with The Banner, Felton sifted through reams of documents and old emails to piece together the timeline of her efforts to get her sister’s home care. She has accumulated boxes and folders full of papers and notes.

The battles application was first rejected in May 2022, two months after submission, due to an error in calculating her assets, she was initially deemed too wealthy to qualify. It took Felton two months to correct it.

Meanwhile, Felton had been working with a support services planner, another necessary step in the process of developing an initial care plan for her sister and liaising with a home care agency and other supports. In July, the support services planner told Felton that they should have assigned her sister to another social worker who would need additional documentation.

The communication then blacked out until the end of August, when they called her to inform her that Battle would be reassigned to another social worker who would start the process again. Felton was later told that her sister was not in the database of waiver applicants, although she later confirmed that her application was pending.

In September, Felton had to re-apply for her sister because it had been six months since her initial application. She filed another set of documents and got another support service planner.

They kept asking the same things over and over, Felton said. His sister often needed to sign something, so Felton had to have it printed and driven from his home in Havre de Grace to the Annapolis nursing home.

In January of this year, Felton was notified that her sister had been approved for subsidized housing, but the vacant apartment would only be held for six months. This meant that time was running out for the Medicaid home care application to be approved, now waiting 10 months.

In March, Felton was punched in the stomach when his sister was denied Medicaid program because his application, last renewed in September, had been pending for more than six months.

I just couldn’t figure it out, Felton said. What was I supposed to do?

Felton began again. Another application, a new nursing assessment for her sister, a new support planner. This time she focused even more, copying everyone involved in every email she sent and making phone calls even more frequently.

In May, with the help of disability advocacy organization Accessible Resources for Independence, which aggressively supported the state on his behalf, Battle was finally passed.

No one should have to live like this

In a virtual town hall hosted by the disability advocacy organization Independence Nowin In early June, 74 people including Medicaid enrollees, family members, lawyers, home-help agencies and the health care workers they employ told often disturbing stories of inordinately long waits for benefits and the harm they caused, while officials state officials listened in silence. Some people have described family members or clients who have died while waiting for treatment.

Certified Nurse Assistant and Home Care Worker Cynthia Neely spoke about her client, 72-year veteran Charles Werrell, who lives alone in the Park Heights neighborhood and has no nearby family to care for him. Werrell has chronic obstructive pulmonary disease (COPD) and uses supplemental oxygen 24 hours a day.

Although Werrell only gets 10 hours of care a week, it’s a lifeline for him, Neely said. He’s unsteady on his feet and prone to falls, he said, so he’s unable to bathe on his own or prepare hot food, and he would go days on end without doing these things when in the past he was without care.

No one should have to live like this, Neely said. i see how much [people] relying on me for basic daily needs and meeting those needs is key to maintaining long-term health, she said, and being able to stay home.

At the end of town hall, Department of Health officials revised its plans to address the backlog of home care applications and workforce shortages, and to design our systems to be much more streamlined and uniform across the nation. our home and community-based services programs, said Marlana Hutchinson, director of the Office of Long Term Services and Supports.

Ryan Moran, deputy secretary for health care financing and director of Medicaid, said the stories shared in City Hall will catalyze our efforts and our commitment to every opportunity that improves operations and experiences for older and disabled adults with Medicaid who need help at home .

Battaglia, meanwhile, still lives in the nursing home. Felton played her part, she said, and is now waiting for the nursing home social worker to complete the process. He hopes nothing else goes wrong.

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