Alzheimer's Waiver to End Without Lawmakers Reprieve

by David Royse
The News Service of Florida

THE CAPITAL, TALLAHASSEE, March 15, 2010: Alzheimer's patients getting community or home-based care through a Medicaid waiver program in four Florida counties are being reminded that the pilot program is set to expire and they need to figure out how they'll get care when it does.

Unless the Legislature intervenes quickly, the Alzheimer's Disease Medicaid Waiver program is set to expire April 30. There are other state Medicaid waiver programs that may be able to pick up some of the patients – though it's not clear if they'll have the money to do so.

“If the Florida Legislature does not change the law to continue the program past this date, you will need to choose another Medicaid home-and-community-based services program to provide your services,” says a letter from the Department of Elder Affairs that has been going out to families of people in the program.

{sidebar id=1}The waiver allows Medicaid money to go to community providers of Alzheimer's care in Broward, Miami-Dade, Palm Beach and Pinellas counties in an effort to let patients remain at home or go to a day care center rather than going into a nursing home.

The letters from Elder Affairs assure families that agency officials will help them find alternatives, and an agency spokesman said Monday that is a priority.

“Our overriding goal, of course, is that every senior who is in that program gets transitioned to something else so there's no break in service,” Elder Affairs spokesman Jon Peck said.

But Mary Barnes, president of Alzheimer's Community Care, Inc. in West Palm Beach urged lawmakers on the House Elder and Family Services Policy Committee to renew the waiver so families aren't forced to make that decision. The non-profit runs 11 day care centers in South Florida.

She said the centers may be almost as important for the caregivers – who get a break from the stress of taking care of an Alzheimer's patient as for the patients themselves. She argues it's more cost effective.

“Nursing homes are the final, most expensive option,” Barnes said in a recent statement. “For one patient in a semi-private room, the cost to taxpayers averages about $65,000 per year.”

It's not clear, however, how much the state saves on the Alzheimer's waiver. A recent study by the Office of Program Policy Analysis and Government Accountability said the Department of Elder Affairs couldn't estimate the cost savings – and analysts found the program didn't delay nursing home entry more effectively than other Medicaid waiver programs that serve elders with Alzheimer’s disease and related dementias.

“In addition, it cost the state more, on average, for participants in the Alzheimer’s disease waiver program than most other waiver programs,” the legislative analysts said. “However, it cost the state less to serve this population through waiver programs than it did to serve similar persons through the traditional Medicaid program.”

Still, for the people getting care through this particular waiver, it matters a lot – and would be a hardship to find new care options, said Barnes.

Rep. Mark Pafford agreed.

“For the people that it's helped locally, it has been really, really important,” said Pafford, D-West Palm Beach and a former CEO of a local Alzheimer's association. He said caregivers need the day care programs for a break.

“Caregivers will predecease their loved ones that they're caring for 60 to 70 percent of the time and its primarily due to stress,” Pafford said. “It's a killer.”

Pafford said he's worried that the other waiver programs may not be funded at levels needed to pick up the 230 patients served by Barnes' organization, for example, and those patients may then be put on waiting lists for other waiver initiatives, or have to go into nursing homes.

Pafford said he's spoken with members of House Republican leadership about the possibility of the Elder Affairs Committee drafting a bill to continue the waiver, but so far, no legislation has been filed. “I'm remaining an optimist,” Pafford said.

This information originally published on March 16, 2010.

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