News From Terre Haute, Indiana


April 10, 2011

FLASHPOINT: Cutting state’s CHOICE program dangerous for citizens and taxpayers

The CHOICE program is in real danger of becoming a needless casualty of the state budget debate. The program stands for Community and Home Options to Institutional Care for the Elderly. The Indiana Family and Social Services Administration has targeted CHOICE for massive cuts in the proposed budget. The so-called cuts are being made without serious consideration of the damage to citizens and the cost to taxpayers. The wise management of CHOICE funds could cut the cost of medical services to the State of Indiana.

CHOICE has been used to provide home-based services to persons who are at risk of nursing home placement. Many wish to remain at home through a combination of care of family, friends and home-based services. The legislation for the program was sponsored by Rep. John Thomas of Brazil in 1987 and has enjoyed bipartisan support because of its cost savings to the state and the care provided.

The answer to what action is needed is quite straightforward since it costs $4,000 per year on average to care for a person under CHOICE and $50,000 in a nursing home. For those persons who have the option and want to stay home, the answer should be simple, give them what they want. With CHOICE, many families never need to turn to Medicaid, because they can stretch their resources with some timely help. A few hours of help can enable a family member to keep working. The absence of help will force many persons to enter nursing homes for lack of an alternative.

FSSA is withholding $7.3 million from the current annual CHOICE budget of $48,765,643. The state administration is asking the Indiana General Assembly to reduce funding to just $18,253,605 for the fiscal year beginning in July 2011 and to provide just $22,965,643 in the second year. These reductions are far in excess to cuts in other state-funded services. The reduced funds will be shifted to provide Medicaid match that is some 30 percent of the cost. The state’s share of $50,000 in nursing home placement is $15,000. The other $35,000 comes from our federal taxes.

So what’s the problem? The Family and Social Services Administration (FSSA) is releasing conflicting cost reports. Last fall the FSSA said CHOICE cost approximately $4,000 per year in state funds, now they are saying it costs $7,000 per year. They say the money is needed for Medicaid match.

Indiana has information from a number of states that demonstrates the wisdom of utilizing state-funded home-based services. Many other states have reduced nursing home placements to cut costs and to provide the services their citizens preferred. The state of Indiana is ignoring what its citizens want. The state of Washington (population 6.6 million compared to Indiana’s population of 6.4M) has deliberately concentrated on providing home-based alternatives to expensive nursing homes. Washington, through quality management, has reduced the number of Medicaid funded nursing home beds to 10,600. FSSA, with its preference for nursing homes, has 28,600 in Medicaid-funded beds.

Indiana continues to have some 5,500 persons on the CHOICE waiting list. Washington has no waiting list. Indiana is spending $1.2 billion on nursing home placements; Washington is spending $580 million on nursing home placements. Washington upgraded the nursing care in its nursing homes with savings earned by fewer placements and directed by some added funding to education. Indiana has earned low marks for the quality of care in a number of nursing homes.

I worry and pray about persons who are elderly or disabled in Indiana and who are being forced into nursing homes. Funding is not the issue since nursing homes cost 10 times more. Why is FSSA allowed to propose this course of action? Why would the General Assembly let it happen? There were crossover votes on second reading of the budget bill. The issue should not be made partisan. The issue should be settled based on its merits.

Glenn Cardwell is former director of the Vigo County office of the Family and Social Services Administration.

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