Medicaid Cuts May Lead to More Spending
The state cut off 17,000 disabled Missourians when it eliminated the Medical Assistance for Workers with Disabilities Program, called MAWD for short.
Some disabled Missourians will make choices in the wake of MAWD that will cost the state much more. Critics say with MAWD gone if you earn a paycheck, you'll pay more for medical coverage. But if you loaf, you'll get taxpayer supported health coverage.
The MAWD program was easy to get: Work one hour per month and get medical care at a low cost. A disabled couple from Columbia is going to quit their jobs, and sell their home just to continue getting health care, all while costing the state more money.
"One should be responsible for ones own life. I had a spinal cord injury in 1963," former MAWD recipient Jim Crotts said.
A once successful Columbia business owner has fought polio since he was 4. Going without medical care for the Crotts would mean not having someone to help them get out of bed in the morning.
"Our already small world will instantly fall apart," Crotts said.
The same home the federal government paid $18,000 to make handicap accessible, now the state government is leaving them with no choice but to sell.
"We have some very hard choices to make, we can either pay our house payment or we can pay our spend down," Crotts said.
Which is like an insurance premium, but with a catch.
"The more money you make, the more money you take out, Crotts said.
So the Crotts quit their jobs to have a lower spend down. Now they're paying $768 a month for that, plus a $726 mortgage. Add in groceries and utilities and it's too much.
"There's not that many people in the state that pay that much to have a premium for health insurance," Columbia Public Administrator Connie Hendren said.
The worst case scenario "that means we'll lose our home" which is more and more likely would be a nursing home.
"(I) can't see anything good about a nursing home other than we'd exist," Crotts said.
For the Crotts to have care attendants 7 days a week for 14 hours a day at $7.75 per hour costs $39,603 a year. A nursing home would cost $117.89 per day for each of them. Totaling over $86,000 a year. The Crotts can pay about $25,000 with their federal disability check, leaving the state with a net cost of $60,812.
"And you multiply that by everybody in that situation, all of those who have personal care attendants what if they can live in the community...I can't even begin to estimate what that number can be," Hendren said.
State officials say the old program was too expensive, $42 million too expensive. The federal government kicked in another $68 million, bringing the total price to around $110 million.
On top of that, state officials say it was faulty.
"There were a number of recipients on the program that were working minimally and avoiding paying a cost sharing or a spend down that others that weren't working at all had to pay," Department of Social Services employee Deborah Scott said.
"It would have been easier to define work that to punish now the individuals who really did work," Scott said, "And the Medicaid reform commission is hearing about it."
"As we move forward I think one of the things you'll see is a new program, that make sure the people who want to work can work and have disabilities will do so without having fear of loosing Medicaid," Medicaid Reform Committee Chairman Sen. Charles Shields said.
Until then, the Crotts can't turn their backs on what their future holds.
"As our life starts to disassemble, we'll be hard pressed to put it back together. It may be too late for us, but maybe it won't be too late for others," Crotts said.
All of this is happening because of Medicaid cuts, cuts that Blunt addressed in his debate with McCaskill on Oct 22 last year.
"Take a look at what he had to say..Cost shifting," Scott said, "that that's what the Medicaid commission is looking at and it. We live on an already strict budget or else they'll go without medical care."
Since MAWD was eliminated, 9,529 Missourians with disabilites were completely cut, and 4,700 including the Crotts have to choose between the "spend down program" or loosing their medical care.
The Crotts filed to appeal their spend down but the state denied it.
Since the cuts, private organizations have helped the Crotts pay their spend down.
The Medicaid Reform Commission's recommendations are due by January 1.
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