Health and Human Services Secretary Robert F. Kennedy, Jr. said this last week when he testified before the U.S. House Ways and Means Committee:
“New York’s State pays on average 80% more per capita on Medicaid than any other state. So 80% over the average. And part of the reason for that, as you point out, are these waiver programs that the states, many of the states have now applied for and received. In the old days, Medicaid paid for medical procedures. So if you got a hernia operation, we could figure that out at CMS. We could see you had a scar, it was done by a licensed doctor, by a licensed nurse, and we could track to make sure it actually happened. The waivers allow people, family members, who are taking care of an elderly parent, who get paid for balancing the checkbook, for picking up the groceries, for driving somebody to a doctor’s appointment. Today, the biggest job in New York, it’s 650,000 people, the biggest employment niche is home care. These are family members who are getting paid to do things that they used to do as family members for free.
“And this is rife with fraud because we have no way, at CMS, to determine whether they actually perform that duty or not.We don’t know whether you drove your grandmother to a doctor’s office. So it’s an opportunity for fraud and state corrupt people. Fraudsters are taking that opportunity all over the country. And it’s one of the reasons that Medicaid doubled during the Biden administration, because we are paying for fraud now as much as for medicine.”
The quiet part, of course, is payers, liked Medicaid, would prefer family caregivers just continue to be 24/7 providers doing all the hard work at no cost to payers. The payers benefit when we remain non-reimbursed family caregivers.
We have so much to unpack:
- The lack of understanding of the responsibility family caregivers hold reveals how little those in power understand what family caregivers actually hold. The caregiving experience means managing 19 Caregiving Systems, including the Medicaid system which can be a nightmare to navigate, for decades.
- Family caregivers manage these responsibilities because their caree can’t. Family caregivers would actually prefer their carees continue to manage their own lives. But they can’t. That’s a sad, heart-breaking experience for two. The emotional toll impacts both family caregiver and caree.
- Neither family caregiver nor caree wants this situation — the need for help from Medicaid, the worry about providing the right amount of help, the terrible feeling that comes from needing to be helped. Truly, both would prefer the complete opposite: the caree is not a caree and lives well independently. The family caregiver is not a family caregiver and lives well.
- Family caregivers save the system money because they prevent unnecessary nursing home placement. Research from the National Academies of Sciences confirms that supporting family caregivers delays nursing home placement, reduces hospital readmissions, decreases emergency room expenditures, and lowers overall Medicaid utilization. The cost difference is significant: Medicaid pays approximately $204 per day for nursing home care. Keeping a caree home — with a family caregiver — costs far less.
- Family caregivers also don’t the receive the reimbursement that the private pay market does. Medicaid reimbursement rates in the state of New York vary by region, county, and agency, generally between $15–$21, but sometimes up to $27.83/hour in specific areas or with overtime. Hiring through a home care agency to provide those same services costs $25 to $40. But reliability and dependability is a huge problem for home care agencies. Family caregivers don’t call out sick.
- Providing transportation involves hard work and a complexity others don’t see. It’s lifting a wheelchair or transport chair into a car trunk, trying to find parking, navigating office buildings that don’t accommodate those who need accommodations, waiting, being hurried through an exam, leaving without really getting the answers you needed — and then lifting the wheelchair again, driving home to complete follow-up next steps: ordering medications, tracking the order, making adjustments to the care plan, providing care, preparing a meal, and worrying you let something important fall through the cracks. Of course, all of this hinges on having your own reliable transportation. Now imagine this scenario when you have to take the bus and organize all of this around a bus schedule.
- A growing Medicaid budget doesn’t indicate fraud. It’s a result of an aging demographic that needs help and probably exhausted all financial resources to pay for help before applying for Medicaid.
- Keeping family caregivers engaged in our local economies stabilizes our local economies. Research estimates that 1 in 4 people provide care; we’re taking a conservative approach to that number. In a community of 100,000 residents, roughly 15,000 may be navigating a caregiving situation. If each family caregiver who once spent just $20 per week visiting local restaurants and shops stops spending, then the monthly cost to the community is $1,200,000. (Check your numbers with our care economy calculator.)
So many in positions of power just don’t get it.
It’s why we still don’t get what we need.
What else don’t those in power get?
Resources
- Check out our interactive tools which help you find your caregiving stage and create your plans to manage your caregiving days.
- We’re writing six-word stories about our uncertainty during caregiving. Add yours.
- Image by Mark Thomas from Pixabay
