The following Op-Ed by Tim Rogers, CEO of the Association for Home and Hospice Care, was published in the News and Observer in response to an earlier editorial by DHHS Secretary Lanier Cansler claiming critical medical care to elderly and disabled patients on Medicaid is not being cut.

N.C. plans crippling cutbacks in Personal Care

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Medicaid Director Craigan L. Gray is cutting home care to 350 Medicaid patients who suffer from MS, Cerebral Palsy and crippling diseases.

Medicaid PDN (Private Duty Nurses) is a little known program that serves 350 of the sickest and frailest people in North Carolina. These patients are paralyzed, have tracheotomies, use ventilators and are fed through tubes. And many are infants and young children.

Please take a moment to look at this video – which tells the story of eleven of these patients.

We will begin airing this video – on the Internet – across North Carolina Monday. And we are sending it to legislators and the press. I thank you for helping make this possible.

Cordially,

Tim Rogers

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Duke Hospital, one of the most respected medical centers in the nation, has a new program that cuts health care costs with a novel use of ‘Home Care.’

Recently a University of California study has demonstrated how Home Care reduces health care costs: By keeping elderly people in their homes and out of more expensive Nursing Homes, by reducing the number of Emergency Room visits, hospital stays - and now with ‘Home Infusion Therapy.’

For years Medicaid has had a bias in favor of institutional care – for instance, by law states must provide Nursing Home Care but not Home Care. But today that’s changing – as part of a new Medicaid program twenty-nine states are embracing Home Care to improve the quality of care, reduce costs – and make patients happier.

Unfortunately, our state’s Medicaid policy remains tilted in favor of sending patients to Nursing Homes. In fact, the state just cut rates to Home Care providers, saying it would save money. But, in fact, the state is being ‘penny-wise and pound-foolish.’ Cutting Home Care rates means fewer providers, which means more patients have no choice but to go into Nursing Homes for care – which costs a lot more. It also means more ER visits. And more hospital stays. All of which lead to higher – not lower – health care costs.

It doesn't make sense: Other states are moving people out of Nursing Homes, back into their own homes - while our state can't move people into Nursing Homes fast enough. 

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As part of a new Medicaid Program twenty-nine states are moving people out of Nursing Homes and into Home Care. A recent article in the New York Times about Walter Brown – a former Nursing Home patient – explains how the program works.  

Mr. Brown, who lives in Philadelphia, had a stroke two years ago and went into a Nursing Home.

“It was,” he told the Times, “like being in jail.”

Now he’s out.

Because  Pennsylvania – as part of the new program – is “reaching out to people like Mr. Brown, who have been in nursing homes for more than six months, aiming to disprove the notion that once people have settled into a nursing home, they will be there forever.”

For years the Times reports, “Medicaid practically steered people into nursing homes.”

“Medicaid,” says Gene Coffey, an attorney with the non-profit National Senior Citizens Law Center, “has had an institutional bias in favor of nursing homes. Federal law requires states to provide nursing home services. But not home or community based services.”

But, now, Pennsylvania is moving patients like Mr. Brown out of Nursing Homes and back into their own homes, where they receive Home Care.

The final savings aren’t clear but a recent study by the University of California found home care costs taxpayers $44,000 a year less than nursing home care.

North Carolina policy still tilts toward sending patients to Nursing Homes – but wouldn’t it be a pleasant change to open the newspaper and read a story like this, where a patient left a Nursing Home and returned to his own home. It could cut health care costs. And make patients – like Mr. Brown – happier. 

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