The Cantwell Amendments: Community Care

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It costs Medicaid about $70,000 a year to keep an elderly American in a nursing home—and often, by the time that elderly American is eligible for a Medicaid-funded nursing home bed, his or her retirement money has already been exhausted.

What if there were a type of elderly care that saved money for both consumers and Medicaid—a program that kept dollars in the government’s pockets and helped seniors hang onto their savings, all while keeping people out of nursing homes when they didn’t need to be in them?

In fact, there is such a thing. Washington State has been a model in pushing it, and Senator Maria Cantwell has offered the idea as another amendment to the Baucus Bill. It’s amendment #C1, to be specific, and its title, though wonky, pretty much explains the idea: Incentives for States to Offer Home and Community Based Services (HCBS) as a Long-Term Care Alternative to Nursing Homes for the Medicaid Population.

Essentially, this amendment would get the federal government into the business of providing matching funds to states that offer “community care” to the elderly—services like fall-prevention classes, nutrition classes, exercise classes, and occasional home health care visits for people for people who need them (for example, a nurse to come and visit a couple times a month to monitor a person’s diabetes medications).

“It’s a quality of life issue,” said Cantwell spokesperson Ciaran Clayton. “I think more people would rather get care at home, or through their primary care doctor, or at their community center, than in a nursing home.”

No doubt true, and the cost savings for Medicaid from paying for fewer nursing home beds could be significant. That’s why Cantwell introduced the amendment in the Senate Finance Committee, and why the committee chairman, Democrat Max Baucus of Montana, has already accepted the idea into the latest draft of his bill.

The federal matching funds would be financed by a 1.45% surtax on short-term capital gains. Full summary of the proposed amendment in the jump.

Cantwell Amendment #C1 to America’s Healthy Future Act of 2009

Short Title: Incentives for States to Offer Home and Community Based Services (HCBS) as a Long-Term Care Alternative to Nursing Homes for the Medicaid Population.

Description of Amendment: This amendment provides a modest, targeted, 5-year-limited increase in federal matching payments (FMAP) for Medicaid covered home and community based services (HBCS). This FMAP increase will be available only to those states willing to undertake certain structural reforms in their Medicaid long-term care programs that have been proven to increase nursing home diversions and access to HCBS. The targeted FMAP increase is offered on a scale based upon the percentage of a state’s long-term care that is offered through HCBS, with lower FMAP increases going to states that will need to make fewer reforms.

This amendment also includes provisions which make it easier for states to provide HCBS under existing Medicaid waiver and option authorities. States will be able to offer HCBS through state plan amendments for targeted populations, including HCBS populations up to 300 percent of the maximum Supplemental Security Income payment.

This amendment reflects S. 1256, the Home and Community Balanced Incentives Act of 2009.

Offset: A 1.45% surtax on short-term capital gains.