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Changes to Medicaid and Medicare could affect in-home patient services

Medicaid cuts could affect in-home patient services

Cynthia Estrada has been caring for patients as a nurse for more than 40 years. These days, she is the administrator for the Desierto Home Care Facility.

“Our population is getting older and our goal is to keep these patients out of the hospital. And that's our goal to begin with -- to keep these patients at the hospital. It's supposed to save money, Medicare money,” Estrada said.

But Estrada and other home-care providers say they are worried about their future and that of their patients after recent state Medicaid cuts.

“What's happening is a lot of these patients are being discharged to the home and needing services but it's becoming more and more difficult for us to provide services that they need or that they require the home,” Estrada said.

In December, a 2015 Texas legislature law went into effect that cut some $350 million in Medicaid funding for speech, occupational and physical therapy programs. The bulk of those cuts could affect children living with disabilities in the state.

However, with the Senate plan to repeal and replace the Affordable Care Act, Medicaid and Medicare providers could lose even more funding. According to a report by the Congressional Budget Office, the plan would cut $800 billion from Medicaid over the next 10 years.

Estrada says the majority of her patients use federally funded Medicare to afford her services.

“About 95 percent of our patients are Medicare and then about 5 percent would be Medicare Advantage plan,” Estrada said.

Many of those patients also rely on state-funded Medicaid to pay for some services. Estrada says her nurses have already started to feel the effects of state Medicaid cuts.

“As far as medication, some patients before, their medications were no problem, they were covered. Then we're going to the homes and then all of the sudden they're telling us, ‘You know what, I was just told that Medicare is not paying for this medication anymore,’” Estrada said.

The cuts are also affecting the number of people who ask for her services.

“It has caused our client list to go down in the sense that was more Medicare Advantage plans ... we're not providers for all of those plans so we're not able to provide care for a lot of these patients,” Estrada said.

She’s worried the Senate health care plan will only worsen the situation.

“You are relying on Medicaid... if that's gone, who's going to take care of these patients?" she said.

Estrada says the recent cuts in Texas and the proposed federal cuts could force some patients out of their homes and into assisted-living facilities.

One program under the Affordable Care Act aims at keeping elderly Americans out of assisted living facilities and in their own homes. Texas and a handful of other states currently take part in the Community First Choice Program, which provides additional Medicaid funding for in-home care providers. However, the current Senate health care plan would dissolve that program in 2021, forcing some elderly Texans into assisted-living facilities.

None of the "patients on our service ... has a long-term insurance,” Estrada said.

She isn’t alone. Dr. Guillermina Solis, an assistant professor at the University of Texas at El Paso’s school of nursing, says she’s already seeing the impact of these cuts.

“The impact is that services are being cut such as maybe aides that are assisting the elderly at their homes. Home-care services are being cut. Also, medications are being cut, so definitely this is affecting the everyday person,” Solis said.

Solis says El Paso could be affected more than other areas because of the sheer number of people who rely on the government for some services.

“We have a large percentage of people in poverty level and so Medicaid is a supplemental service that is provided to the Medicare and you have to qualify for it,” Solis said.

Some of the nurses she trains at UTEP have already expressed concern about how these changes to government programs are affecting the care they provide.

“The concerns that they have is that the clinical guidelines state that they should be doing this but then the patient doesn't have the resources. So how do they help the patient adapt to this? And so the question is already being raised and already there's been adaptations and modifications that have been done. I can just imagine how detrimental it would be if we cut services and provisions even further,” Solis said.

Solis says she’s worried that, as an aging Texan, she and others could be caught dealing with the same issues as some patients.

“We're all going to be in that same situation and unfortunately, it's just not looking very bright right now,” she said. “It's not just going to affect medications; it’s also going to affect the service listing provided in the community,” Solis said.

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