Editorial: Pending reimbursement cuts put disabled at risk

The Idaho Department of Health and Welfare has decided providers of in-home care for the developmentally disabled live in a 2006 world.

Last week, the department announced reimbursements for those who help the disabled with everything from personal hygiene to job training will revert to levels of a decade ago as of Jan. 1. In response to provider backlash, implementation was stayed until February.

The cuts will hit those with the most difficult, “intense” cases hardest. Paid $500 as a result of a 2011 U.S. District Court ruling, they will instead get 40 percent less: $270. Caretakers of those who need a “high” level of support will take a 9 percent cut, to $225 per person, but they may care for more than one client.

In May, the U.S. Supreme Court ruled 5-4 that providers cannot challenge the rates. The decision set aside a U.S. District Court judgment. The department says the state had to wait to announce the cuts while the Centers for Medicare & Medicaid Services reviewed them.

Medicaid covers 100 percent of the reimbursements; the federal share being 70 percent, the state share 30 percent.

But consider a pair of benchmarks that might put the adequacy of the 2006 rates in perspective:

The minimum wage has been reset from $5.15 to $7.25, although some providers pay more to their workers. Food Stamp aid has increased from $91.62 per person to $116.34.

Idaho law requires the department to survey all home-care providers to determine their costs, and set the reimbursement rate to cover those costs. The Legislature must approve the rates. But the department declined to follow the recommendations of a consultant that conducted a 2009 survey, which triggered the lawsuit by providers.

The department’s position then, as it is now, is that the 2006 rates were sufficient to guarantee access for all those who were eligible, and that the absence of complaints indicated clients were receiving satisfactory care.

A spokesman says the department will undertake another cost survey next year. But because reaching every provider can take six months or more, whatever recalculation of rates is made will likely not go to the Legislature until 2017.

In the meantime, one major provider says it will have to borrow money to cover the gap between its costs and reimbursements. That option may not be available to all 60-plus providers, especially when potential lenders will not know whether future rates will enable borrowers to repay.

The fates of 1,364 in-home care recipients are in play. If providers drop out of the market, they may have to be placed in institutions, where the care is less personal and more expensive.

Department leaders say they will not let that happen. It does not have to.

Adopting the 2006 rates will save $20 million a year, of which Idaho’s share is $5.8 million. Rather than put client care at risk, the state should accelerate its survey — providers certainly have every reason to cooperate — and stay the cuts until the Legislature can act on the findings.

Avoiding harm to a fragile client population should be a priority.