Michigan Campaign For Quality Care

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June, 2005

1. Please join us at our next statewide meeting on June 18, 2005 from 10:30 - 2:30 in the Lake Superior Room, Library of Michigan, 717 West Allegan, Lansing. (And please plan to join us on September 17 and November 19 at the same time and place!)

2. Governor’s Task Force unveils wide-ranging recommendations for long term care reform–The Governor’s Medicaid Long Term Care Task Force has completed its effort to analyze Michigan’s fragmented, inadequate long term care system. The 21 member bipartisan group made unanimous recommendations regarding how the state can provide more choice and quality in long term care and ensure our system is cost effective and efficient. The full report is available at http://www.ihcs.msu.edu/LTC/default.htm. Key concepts include:

É Creating a "Single Point of Entry" for long term care consumers. These regional agencies would provide information to consumers seeking long term care, determine eligibility for various long term care programs, use "person centered planning" to ensure consumers are encouraged and enabled to make their own choices, provide advocacy and care management, etc. Medicaid recipients would be required to use the single points of entry; other consumers could use these agencies if they wish. The Task Force recommended that the state create three regional single points of entry within a year and single points of entry across the state within three years.

É Money Follows the Person–Under this system, long term care funding would pay for whatever long term care program or service a consumer chooses and for which he or she is eligible. Funds would no longer be rigidly allocated by the state for limited slots in particular programs or beds in nursing homes but would fund whatever service consumers choose.

É Case mix reimbursement–Under this system of reimbursement, providers would be paid more money for consumers who require more intense or frequent services and less money for low needs consumers instead of receiving a flat rate for all of their clients. If the reimbursement levels are set appropriately, this payment system should reduce discrimination against high needs consumers.

É Creation of a Long Term Care Administration and Long Term Care Commission – These recommendations address the current fragmentation in and lack of coordination and oversight of the long term care system. The Task Force proposed creating a single Long Term Care Administration to ensure all long term care services are carefully coordinated and cost effective, consistent with the state’s vision of quality long term care services, and focused on consumer choice and autonomy. The Task Force also recommended the creation of a Long Term Care Commission with a majority of consumer members to oversee the state’s long term care programs and demand accountability.

3. State Senate and House committees propose cuts in the MiChoice Home and Community Based Waiver Program– Both the state Senate and House are considering proposals to cut funding to the MiChoice Home and Community Based Waiver Program, the Medicaid program that allows people who need nursing home level of care to receive that care in their own homes instead of in nursing homes. MiChoice is extremely popular with consumers and there are long waiting lists for it all over the state. Waiver programs like MiChoice have been used very successfully to control costs and meet consumer needs in other states and MiChoice is a crucial element of any effort to reform long term care in this state.

As many Campaign members remember, the Campaign was one of the plaintiffs in a 2002 lawsuit, Eager, et al. v. Engler, et al., challenging then Governor Engler’s reduction in funding to MiChoice which resulted in the closure of the program to new applicants. As a result of the successful settlement of that case last year, the program was reopened, a number of substantive changes were made, and the Governor’s Task Force was created.

It is deeply distressing to see new attacks on MiChoice at the very same time we finally have a blueprint for real reform from the Governor’s Long Term Care Task Force. Many of those reforms simply cannot happen unless and until MiChoice has capacity to provide services to more long term care consumers.

Please call your legislators today to urge them to expand, not cut, the MiChoice program. Adequate funding for MiChoice will result in long term savings (because home care is more cost effective than expensive nursing home care); meet the requirements of the Americans with Disabilities Act and the U.S. Supreme Court’s Olmstead decision; follow the lead of other states; respond to overwhelming consumer demand; and be consistent with the Bush Administration’s recommendations,the Granholm Administration’s goals, and the recommendations of the Task Force.

4. Rep. Vander Veen introduces bill regarding dining assistants; federal court lawsuit on dining assistants moves forward –Rep. Barb Vander Veen (R-Ottawa County) introduced H.B. 4789 which would have permitted feeding assistants (single task workers with less training than a nursing assistant) to help nursing home residents with meals. However, the Campaign and other providers, advocates and state officials have been working for more than a year to devise a dining assistant pilot project which will be evaluated by MSU researchers to determine the risks and benefits for residents. The pilot project is due to begin this summer in a limited number of homes. In response to the Campaign’s concerns, Rep. Vander Veen kindly agreed to redraft the legislative proposal to incorporate the pilot project and to hold off on decisions regarding statewide implementation of the dining assistant program until the results of the MSU study are available.

In related news, a federal judge has ruled on a number of motions in a lawsuit challenging the federal regulation that permits states to create feeding ("dining") assistant programs. The judge decided that the Campaign and an individual Michigan nursing home resident did not have "standing" to pursue the lawsuit since Michigan has not yet permitted feeding assistants and Michigan residents are therefore not harmed by the federal regulation. Because the state of Washington has implemented a feeding assistant program, however, the judge permitted the Resident Councils of Washington and the Washington state ombudsman program to continue to pursue the lawsuit. We are now awaiting a final decision whether the federal feeding assistant regulation violates the Nursing Home Reform Law. If the court agrees that the regulation is illegal, no state will be allowed to authorize nursing homes to hire feeding assistants.

5. State Ombudsman Sarah Slocum is addressing intimidation of family members and family councils by nursing homes–The state ombudsman program is responding to incidents of intimidation by nursing homes against family councils and families that advocate vigorously for residents. This problem has been noted in some homes here and across the country. We appreciate the strong advocacy on this issue by state and local ombudsman staff and will keep you posted.

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The Campaign appreciates recent generous donations by Marian McKnight and Bay Senior Advocates.