There are times when government has to make hard choices between doing things that are humane and things that are fiscally responsible. But thankfully, those two imperatives sometimes line up.
One example is a Missouri program that provides in-home care to thousands of low-income disabled state residents, allowing them to remain in their homes with the assistance of visiting caregivers, instead of having to go into nursing care.
They get the crucial independence that comes from living at home; the state gets a cheaper bill than a nursing home would entail.
Given all that, why would the Missouri Legislature cut the program by more than $40 million? The cuts, first instituted last year, affect more than 7,800 Missourians, some of whom are now in danger of having to move into nursing homes. This is not only heartless, it's a classic case of penny-wise/pound-foolish. Lawmakers should restore that funding as soon as possible.
The program operates under Medicaid, the state-run health care system for the poor, which is heavily subsidized by the federal government. The cuts – initially $50 million, with $8 million later restored – came in the form of both caps on the services and rate cuts to the providers, all part of the state's efforts to balance the budget. The majority of the money saved by the cuts was federal, with just $18 million of it coming from the state. That relatively small savings may ultimately be undone by added costs if many of the clients end up having to go into nursing homes.
Even if the cuts just result in increases in short-term hospitalization – a real possibility, experts say – the savings would be wiped out. The cuts saved an average of $5,321 per participant per year, while it costs roughly $9,000 for a Medicaid patient for one hospital stay. "Just one hospitalization due to lack of care cancels out any savings," says Paraquad, a St. Louis-based nonprofit organization that helps people with disabilities.
As the Post-Dispatch reported last week, disabled residents and the specialists who work with them are dismayed by both the insensitivity and fiscal short-sightedness of the cuts. Steve Foelsch, 53, a quadriplegic who is paralyzed from the chest down, lives at home in St. Louis with the aid of the program. "All the money that I have gets pumped right back into the St. Louis economy," Foelsch said. "You put me in a nursing home, and you're paying some national conglomerate money, and that may be going to New Jersey or Nevada."
Suzan Weller of Disability Resource Association added, "What it comes down to is dignity and respect of a human life." That argument should be enough, but the fiscal argument is also there. Either way, the Legislature should restore the funding.
– St. Louis Post-Dispatch